title: Responses of mental stress-induced myocardial ischemia to escitalopram treatment: background, design, and method for the Responses of Mental Stress Induced Myocardial Ischemia to Escitalopram Treatment trial.
abstract: BACKGROUND
  Mental stress-induced myocardial ischemia (MSIMI) is common in patients with clinically stable coronary heart disease (CHD) and is associated with poor outcomes. Depression is a risk factor of MSIMI. The REMIT trial investigates whether selective serotonin reuptake inhibitor (SSRI) treatment can improve MSIMI. The rationale and outline of the study are described.
  
  
  METHODS
  In this single-center randomized clinical trial, adult patients with clinically stable CHD are recruited for baseline mental and exercise stress testing assessed by echocardiography. In addition, psychometric questionnaires are administered, and blood samples are collected for platelet activity analysis. Patients who demonstrate MSIMI, defined by new abnormal wall motion, ejection fraction reduction ≥8%, and/or development of ischemic ST change in electrocardiogram during mental stress testing, are randomized at a 1:1 ratio to escitalopram or placebo for 6 weeks. Approximately 120 patients with MSIMI are enrolled in the trial. The stress testing, platelet activity assessment, and psychometric questionnaires are repeated at the end of the 6-week intervention. The hypothesis of the study is that SSRI treatment improves MSIMI via mood regulation and modification of platelet activity.
  
  
  CONCLUSIONS
  The REMIT study examines the effect of SSRI on MSIMI in vulnerable patients with CHD and probes some potential underlying mechanisms.
authors.affiliation: Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, USA. jiang001@mc.duke.edu
authors.forename: Wei
authors.initials: W
authors.lastname: Jiang
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Velazquez
authors.forename: Zainab
authors.initials: Z
authors.lastname: Samad
authors.forename: Maragatha
authors.initials: M
authors.lastname: Kuchibhatla
authors.forename: Carolyn
authors.initials: C
authors.lastname: Martsberger
authors.forename: Joseph
authors.initials: J
authors.lastname: Rogers
authors.forename: Redford
authors.initials: R
authors.lastname: Williams
authors.forename: Cynthia
authors.initials: C
authors.lastname: Kuhn
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Ortel
authors.forename: Richard C
authors.initials: RC
authors.lastname: Becker
authors.forename: Nicole
authors.initials: N
authors.lastname: Pristera
authors.forename: Ranga
authors.initials: R
authors.lastname: Krishnan
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
mesh_terms: D000328:Adult; D002318:Cardiovascular Diseases / Q000188:drug therapy* / Q000401:mortality / Q000523:psychology; D015283:Citalopram / Q000008:administration & dosage*; D003866:Depressive Disorder / Q000150:complications* / Q000188:drug therapy; D005080:Exercise Test; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy / Q000401:mortality / Q000523:psychology; D011594:Psychometrics; D012107:Research Design; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage*; D013315:Stress, Psychological / Q000150:complications* / Q000188:drug therapy; D016896:Treatment Outcome
chemical_list: D015283:Citalopram; D017367:Selective Serotonin Reuptake Inhibitors