Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC, USA.
Am Heart J. 2012 Jan;163(1):20-6. doi: 10.1016/j.ahj.2011.09.018. Epub 2011 Nov 14.
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.
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.
The REMIT study examines the effect of SSRI on MSIMI in vulnerable patients with CHD and probes some potential underlying mechanisms.
精神应激诱发的心肌缺血(MSIMI)在临床上稳定的冠心病(CHD)患者中很常见,与不良预后相关。抑郁是 MSIMI 的一个危险因素。REMIT 试验研究了选择性 5-羟色胺再摄取抑制剂(SSRI)治疗是否能改善 MSIMI。本文描述了研究的原理和概述。
在这项单中心随机临床试验中,招募了患有临床上稳定的 CHD 的成年患者进行基线心理和运动应激测试,通过超声心动图进行评估。此外,还进行了心理计量问卷评估,并采集血样进行血小板活性分析。在心理应激测试期间出现新的异常壁运动、射血分数降低≥8%和/或心电图出现缺血性 ST 改变的患者被定义为 MSIMI,他们将以 1:1 的比例随机分为依地普仑或安慰剂组,进行 6 周的治疗。该试验大约纳入了 120 例 MSIMI 患者。在 6 周干预结束时,重复进行应激测试、血小板活性评估和心理计量问卷评估。该研究的假设是,SSRI 通过调节情绪和改变血小板活性来改善 MSIMI。
REMIT 研究检查了 SSRI 对易患 CHD 的患者 MSIMI 的影响,并探讨了一些潜在的机制。