Jiang Wei, Babyak Michael A, Rozanski Alan, Sherwood Andrew, O'Connor Christopher M, Waugh Robert A, Coleman R Edward, Hanson Michael W, Morris James J, Blumenthal James A
Departments of Department ofPsychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC 27710, USA.
Am Heart J. 2003 Jul;146(1):55-61. doi: 10.1016/S0002-8703(03)00152-2.
Depression is relatively common in patients with ischemic heart disease (IHD) and is associated with increased risk of mortality and morbidity. However, the mechanisms by which depression adversely affects clinical outcomes of patients with IHD are unknown. This study examined the relationship between depression and myocardial ischemia during mental stress testing and during daily living in patients with stable IHD.Methods and results The Center for Epidemiological Studies-Depression scale (CES-D) was administered to 135 patients with IHD to evaluate depressive symptoms. Radionuclide ventriculography was used to evaluate the occurrence of left ventricular wall motion abnormality (WMA) during mental stress and exercise testing. Forty-eight-hour ambulatory electrocardiography was used to assess myocardial ischemia during daily living. The mean CES-D score was 8.2 (SD 7.4, range 0-47) with a median of 7. Logistic regression models using restricted cubic splines revealed a curvilinear relation among CES-D scores and the probability of ischemia. For patients with CES-D scores <or=19 (81.5% of study population), a 5-point increment in the CES-D score was associated with roughly a 2-fold increase in the likelihood of ischemia during mental stress. For patients with CES-D scores >19, the relation among scores and ischemia during mental stress tended to be inversely related, but the portion of the sample is very small. Similar patterns of results were noted for CES-D scores and ischemia during daily life.
Patients with mild to moderate depressive symptoms (CES-D scores <or=19) are more likely to exhibit myocardial ischemia during mental stress testing and during daily living. Myocardial ischemia may be one mechanism by which depression increases the risk of mortality and morbidity in patients with IHD. The observed inverse association between higher level of depressive symptoms and ischemic activity needs to be further assessed in large samples.
抑郁症在缺血性心脏病（IHD）患者中相对常见，且与死亡率和发病率增加相关。然而，抑郁症对IHD患者临床结局产生不利影响的机制尚不清楚。本研究调查了稳定型IHD患者在心理应激测试期间及日常生活中抑郁症与心肌缺血之间的关系。
对135例IHD患者采用流行病学研究中心抑郁量表（CES-D）评估抑郁症状。采用放射性核素心室造影评估心理应激和运动测试期间左心室壁运动异常（WMA）的发生情况。采用48小时动态心电图评估日常生活期间的心肌缺血情况。CES-D平均得分为8.2（标准差7.4，范围0 - 47），中位数为7。使用受限立方样条的逻辑回归模型显示CES-D得分与缺血概率之间呈曲线关系。对于CES-D得分≤19的患者（占研究人群的81.5%），CES-D得分增加5分与心理应激期间缺血可能性大致增加2倍相关。对于CES-D得分>19的患者，心理应激期间得分与缺血之间的关系趋于负相关，但样本量非常小。日常生活期间CES-D得分与缺血情况也呈现类似的结果模式。
轻度至中度抑郁症状（CES-D得分≤19）的患者在心理应激测试期间及日常生活中更易出现心肌缺血。心肌缺血可能是抑郁症增加IHD患者死亡率和发病率风险的一种机制。抑郁症状水平较高与缺血活动之间观察到的负相关关系需要在大样本中进一步评估。
