Confluence of Depression and Acute Psychological Stress Among Patients With Stable Coronary Heart Disease: Effects on Myocardial Perfusion
Open accessAbstract
Background: 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 . Methods and Results: Patients (N=146) completed the B eck D epression I nventory‐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. Conclusions: 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.
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Acute mental stress combined with psychological distress has been linked to inducible myocardial ischemia among patients with coronary artery disease.
“Acute instances of mental stress combined with psychological distress (eg, depression) has also been linked to inducible myocardial ischemia among patients with coronary artery disease. 109-111”
From Psychological Health, Well-Being, and the Mind-Heart-Body Connection: A Scientific Statement From the American Heart Association (2021) · cites this paper as [111]
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- Authors
- Burg, M. M., Meadows, J., Shimbo, D., Davidson, K. W., Schwartz, J. E., & Soufer, R.
- Affiliations
- Columbia University Irving Medical Center (US)
- Yale University (US)
- ORCID
- Venue
- Journal of the American Heart Association
- Published
- 2014-12-17
- Volume
- 3
- Issue
- 6
- Pages
- e000898-e000898
- ISSN
- 2047-9980 (ISSN-L)
- PMC
- PMC4338683
- OpenAlex
- W2121327108
- Cited by
- 42
- References
- 48
- Citations by year
- 2026: 3 · 2025: 1 · 2023: 1 · 2022: 7 · 2021: 4 · 2020: 1 · 2019: 8 · 2017: 6 · 2016: 8 · 2015: 3
- FWCI
- 3.89
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- Journal of the American Heart Association (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Columbia Academic Commons (Columbia University)
- Funders
- U.S. Department of Veterans Affairs (I01 CX000935)
- National Institutes of Health (UL1TR000142)
- National Heart, Lung, and Blood Institute (R01 HL59619/H159619, R01HL059619, R01HL084438, P01HL088117)
- National Center for Advancing Translational Sciences
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
- Health Sciences › Medicine › Radiology, Nuclear Medicine and Imaging › Cardiac Imaging and Diagnostics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Keywords
- depression, acute psychological stress, stable coronary artery disease, myocardial perfusion, myocardial perfusion imaging, Beck Depression Inventory, selective serotonin reuptake inhibitors, depression and cardiovascular risk
- MeSH terms
- Aged, Chronic Disease, Connecticut, Coronary Circulation, Coronary Disease, Depression, Female, Hemodynamics, Humans, Male, Middle Aged, Predictive Value of Tests, Psychiatric Status Rating Scales, Recurrence, Risk Factors, Severity of Illness Index, Stress, Psychological, Tomography, Emission-Computed, Single-Photon, Multivariate Analysis, Chi-Square Distribution, Logistic Models, Odds Ratio, Acute Coronary Syndrome, Myocardial Perfusion Imaging
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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