title: Depressive symptoms are associated with mental stress-induced myocardial ischemia after acute myocardial infarction.
abstract: OBJECTIVE
  Depression 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.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  There 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.
  
  
  CONCLUSIONS
  Among 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.
authors: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
authors: Jingkai
authors: J
authors: Wei
authors: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
authors: Pratik
authors: P
authors: Pimple
authors: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America; Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, United States of America.
authors: Amit J
authors: AJ
authors: Shah
authors: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
authors: Cherie
authors: C
authors: Rooks
authors: Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia, United States of America.
authors: J Douglas
authors: JD
authors: Bremner
authors: Department of Radiology, Emory University School of Medicine, Atlanta, Georgia, United States of America.
authors: Jonathon A
authors: JA
authors: Nye
authors: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
authors: Ijeoma
authors: I
authors: Ibeanu
authors: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
authors: Nancy
authors: N
authors: Murrah
authors: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America.
authors: Lucy
authors: L
authors: Shallenberger
authors: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America; Mazankowski Alberta Heart Institute, University of Alberta School of Medicine, Edmonton, Alberta, Canada.
authors: Paolo
authors: P
authors: Raggi
authors: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, United States of America; Department of Medicine, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, United States of America.
authors: Viola
authors: V
authors: Vaccarino
mesh_terms: D000293:Adolescent; D000328:Adult; D003863:Depression / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D015444:Exercise; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000503:physiopathology*; D017202:Myocardial Ischemia / Q000150:complications / Q000503:physiopathology*; D055414:Myocardial Perfusion Imaging; D011379:Prognosis; D011569:Psychiatric Status Rating Scales; D013315:Stress, Psychological / Q000150:complications / Q000503:physiopathology*