Burg Matthew M, Meadows Judith, Shimbo Daichi, Davidson Karina W, Schwartz Joseph E, Soufer Robert
Section of Cardiovascular Medicine, VA Connecticut, West Haven, CT (M.M.B., J.M., R.S.) Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (M.M.B., J.M., R.S.) Center for Behavioral Cardiovascular Health, Columbia University School of Medicine, New York, NY (M.M.B., D.S., K.W.D., J.E.S.).
Section of Cardiovascular Medicine, VA Connecticut, West Haven, CT (M.M.B., J.M., R.S.) Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT (M.M.B., J.M., R.S.).
J Am Heart Assoc. 2014 Oct 30;3(6):e000898. doi: 10.1161/JAHA.114.000898.
Depression is prevalent in coronary heart disease (CHD) patients and increases risk for acute coronary syndrome (ACS) recurrence and mortality despite optimal medical care. The pathways underlying this risk remain elusive. Psychological stress (PS) can provoke impairment in myocardial perfusion and trigger ACS. A confluence of acute PS with depression might reveal coronary vascular mechanisms of risk. We tested whether depression increased risk for impaired myocardial perfusion during acute PS among patients with stable CHD.
Patients (N=146) completed the Beck Depression Inventory-I (BDI-I), a measure of depression linked to recurrent ACS and post-ACS mortality, and underwent single-photon emission computed tomography myocardial perfusion imaging at rest and during acute PS. The likelihood of new/worsening impairment in myocardial perfusion from baseline to PS as a function of depression severity was tested. On the BDI-I, 41 patients scored in the normal range, 48 in the high normal range, and 57 in the depressed range previously linked to CHD prognosis. A BDI-I score in the depressed range was associated with a significantly greater likelihood of new/worsening impairment in myocardial perfusion from baseline to PS (odds ratio =2.89, 95% CI: 1.26 to 6.63, P=0.012). This remained significant in models controlling ACS recurrence/mortality risk factors and medications. There was no effect for selective serotonin reuptake inhibitor medications.
Depressed patients with CHD are particularly susceptible to impairment in myocardial perfusion during PS. The confluence of PS with depression may contribute to a better understanding of the depression-associated risk for ACS recurrence and mortality.
抑郁症在冠心病（CHD）患者中很常见，尽管接受了最佳医疗护理，但仍会增加急性冠状动脉综合征（ACS）复发和死亡的风险。这种风险背后的机制仍然难以捉摸。心理压力（PS）可导致心肌灌注受损并引发ACS。急性PS与抑郁症的共同作用可能揭示风险的冠状动脉血管机制。我们测试了抑郁症是否会增加稳定型CHD患者在急性PS期间心肌灌注受损的风险。
患者（N = 146）完成了贝克抑郁量表 - I（BDI - I），这是一种与复发性ACS和ACS后死亡率相关的抑郁测量工具，并在静息状态和急性PS期间接受了单光子发射计算机断层扫描心肌灌注成像。测试了从基线到PS时心肌灌注新出现/恶化受损的可能性与抑郁严重程度的关系。在BDI - I上，41名患者得分在正常范围内，48名在高正常范围内，57名在先前与CHD预后相关的抑郁范围内。BDI - I得分在抑郁范围内与从基线到PS时心肌灌注新出现/恶化受损的可能性显著增加相关（优势比 = 2.89，95% CI：1.26至6.63，P = 0.012）。在控制ACS复发/死亡风险因素和药物的模型中，这一结果仍然显著。选择性5-羟色胺再摄取抑制剂药物没有效果。
患有CHD的抑郁症患者在PS期间特别容易出现心肌灌注受损。PS与抑郁症的共同作用可能有助于更好地理解与抑郁症相关的ACS复发和死亡风险。
