title: Depressive symptoms and mental stress-induced myocardial ischemia in patients with coronary heart disease.
abstract: OBJECTIVE
  The aim of this study was to examine the associations between depressive symptoms and mental stress-induced myocardial ischemia (MSIMI) in patients with coronary heart disease (CHD).
  
  
  METHODS
  Adult patients with documented CHD were recruited for baseline mental stress and exercise stress screening testing as a part of the enrollment process of the Responses of Myocardial Ischemia to Escitalopram Treatment trial. Patients were administered the Beck Depression Inventory II and the Center for Epidemiologic Studies Depression Scale. After a 24-48-hour β-blocker withdrawal, participants completed three mental stress tests followed by a treadmill exercise test. Ischemia was defined as a) any development or worsening of any wall motion abnormality and b) reduction of left ventricular ejection fraction at least 8% by transthoracic echocardiography and/or ischemic ST-segment change by electrocardiography during stress testing. MSIMI was considered present when ischemia occurred in at least one mental test. Data were analyzed using logistic regression adjusting for age, sex, and resting left ventricular ejection fraction.
  
  
  RESULTS
  One hundred twenty-five (44.2%) of 283 patients were found to have MSIMI, and 93 (32.9%) had ESIMI. Unadjusted analysis showed that Beck Depression Inventory II scores were positively associated with the probability of MSIMI (odds ratio = 0.1.30: 95% confidence interval = 1.06-1.60, p = .013) and number of MSIMI-positive tasks (all p < .005). These associations were still significant after adjustment for covariates (p values <.05).
  
  
  CONCLUSIONS
  In patients with CHD, depressive symptoms were associated with a higher probability of MSIMI. These observations may enhance our understanding of the mechanisms contributing to the association of depressive symptoms to future cardiovascular events. Trial Registration Clinicaltrials.gov identifier: NCT00574847.
authors.affiliation: Duke University Medical Center, Box 3366, Durham, NC 27710. shboyle@mc.duke.edu.
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Boyle
authors.forename: Zainab
authors.initials: Z
authors.lastname: Samad
authors.forename: Richard C
authors.initials: RC
authors.lastname: Becker
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: Maragatha
authors.initials: M
authors.lastname: Kuchibhatla
authors.forename: Kevin
authors.initials: K
authors.lastname: Prybol
authors.forename: Joseph
authors.initials: J
authors.lastname: Rogers
authors.forename: Christopher
authors.initials: C
authors.lastname: O'Connor
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Velazquez
authors.forename: Wei
authors.initials: W
authors.lastname: Jiang
mesh_terms: D000328:Adult; D001007:Anxiety / Q000453:epidemiology; D003327:Coronary Disease / Q000453:epidemiology* / Q000503:physiopathology; D003863:Depression / Q000453:epidemiology*; D004452:Echocardiography; D004562:Electrocardiography; D005080:Exercise Test / Q000706:statistics & numerical data; D005260:Female; D006791:Hostility; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000209:etiology; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000150:complications / Q000453:epidemiology*
keywords: coronary heart disease; depressive symptoms; exercise-induced myocardial ischemia; mental stress–induced myocardial ischemia