Depressive Symptoms Are Associated with Mental Stress-Induced Myocardial Ischemia after Acute Myocardial Infarction

Abstract

ObjectivesDepression is an adverse prognostic factor after an acute myocardial infarction (MI), and an increased propensity toward emotionally-driven myocardial ischemia may play a role. We aimed to examine the association between depressive symptoms and mental stress-induced myocardial ischemia in young survivors of an MI.MethodsWe studied 98 patients (49 women and 49 men) age 38–60 years who were hospitalized for acute MI in the previous 6 months. Patients underwent myocardial perfusion imaging at rest, after mental stress (speech task), and after exercise or pharmacological stress. A summed difference score (SDS), obtained with observer-independent software, was used to quantify myocardial ischemia under both stress conditions. The Beck Depression Inventory-II (BDI-II) was used to measure depressive symptoms, which were analyzed as overall score, and as separate somatic and cognitive depressive symptom scores.ResultsThere was a significant positive association between depressive symptoms and SDS with mental stress, denoting more ischemia. After adjustment for demographic and lifestyle factors, disease severity and medications, each incremental depressive symptom was associated with 0.14 points higher SDS. When somatic and cognitive depressive symptoms were examined separately, both somatic [β = 0.17, 95% CI: (0.04, 0.30), p = 0.01] and cognitive symptoms [β = 0.31, 95% CI: (0.07, 0.56), p = 0.01] were significantly associated with mental stress-induced ischemia. Depressive symptoms were not associated with ischemia induced by exercise or pharmacological stress.ConclusionAmong young post-MI patients, higher levels of both cognitive and somatic depressive symptoms are associated with a higher propensity to develop myocardial ischemia with mental stress, but not with physical (exercise or pharmacological) stress.

Acute Myocardial Infarction in Women

“…Because mental stress ischemia induced in the laboratory correlates with ischemia in daily life, 430 it could also be a more frequent trigger of AMI in young women than in other groups. Recent evidence also links depression to mental stress-induced ischemia, 431,432 providing a new explanatory pathway for the worse prognosis of MI patients with depression, many of whom are women, compared with those without depression.…”

Autonomic dysfunction and heart rate variability in depression

“…Individuals with major depression are much more likely to suffer coronary artery disease and acute cardiovascular sequelae such as myocardial infarction, congestive heart failure and hypertension (Nemeroff & Goldschmidt-Clermont, 2012). In addition, elevated depressive symptoms predict mental stress-induced myocardial ischemia after acute myocardial infarction (Wei et al, 2014) as well as long-term cardiovascular mortality in patients with atrial fibrillation and congestive heart failure (Frasure-Smith & Lespérance, 2010). This comorbidity is a relevant public health concern, given that CVD and depression are some of the leading causes of disability worldwide and are forecasted to be the two main disease burdens by 2020 (Licinio et al, 2002;Mathers & Loncar, 2006;Murray & Lopez, 1997).…”

Do Women With Anxiety or Depression Have Higher Rates of Myocardial Ischemia During Exercise Testing Than Men?

“…42,43 The lack of an effect of mood is also surprising given the relationship between laboratory-induced ischemia and future cardiac events [44][45][46] ; however, it should be noted that this is more commonly seen when inducing ischemia via mental stress. The choice of stressor may be important to determine the effect of depression on ischemia; mentalstress-induced ischemia is related to depressive symptoms, 47,48 whereas inconsistent evidence exists to a relationship between depression and exercise-induced ischemia. 47,48 Furthermore, as there was a trend for mood disorder to be negatively correlated with exercise duration (r=−0.04; P=0.07), it is possible that patients with mood disorder may not have performed an optimal test, making it less likely and harder to detect ischemia.…”

“…The choice of stressor may be important to determine the effect of depression on ischemia; mentalstress-induced ischemia is related to depressive symptoms, 47,48 whereas inconsistent evidence exists to a relationship between depression and exercise-induced ischemia. 47,48 Furthermore, as there was a trend for mood disorder to be negatively correlated with exercise duration (r=−0.04; P=0.07), it is possible that patients with mood disorder may not have performed an optimal test, making it less likely and harder to detect ischemia. 49,50 No such relationship between anxiety and exercise duration was evident (r<0.01; P=0.73).…”