Document Detail


Are exercise stress tests appropriate for assessing myocardial ischemia in patients with major depressive disorder?
MedLine Citation:
PMID:  15459592     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Major depressive disorder (MDD) disproportionately affects patients with coronary artery disease (CAD). Evidence of myocardial ischemia with electrocardiography (ECG) or single-photon-emission-computed-tomography (SPECT) assessments during exercise testing is an important determinant of CAD prognosis. However, many key symptoms of MDD, such as reduced interest in daily activities, lack of energy, and fatigue, may affect exercise performance and the detection of ischemia in patients with MDD. This study evaluated the extent to which MDD and depressive symptomatology moderate exercise test performance and compared the ability of ECG versus SPECT for detecting ischemia in 1367 consecutive patients who underwent exercise testing. METHODS: All patients underwent a brief, structured psychiatric interview (PRIME-MD) and completed the Beck Depression Inventory (BDI) on the day of their exercise (treadmill) test. RESULTS: A total of 183 patients (13%) met diagnostic criteria for MDD. Patients with MDD achieved a significantly lower percent of maximal predicted heart rate (%MPHR), exhibited lower peak exercise mets, and spent less time exercising compared with patients without MDD (all P values <.05). BDI scores were also negatively correlated with all 3 indices of exercise performance (all P values <.01). There were no differences in rates of SPECT ischemia in patients with MDD (40%) versus patients without MDD (45%; P =.23); however, rates of ECG ischemia were significantly lower (30%) in patients with MDD than in patients without MDD (48%; P <.0001). CONCLUSIONS: Results suggest that patients with CAD who have MDD, depressive symptomatology, or both exhibit poor exercise tolerance and performance and that ECG, as compared with SPECT, may not be as reliable in detecting ischemia in patients who are depressed.
Authors:
Kim L Lavoie; Richard P Fleet; Francois Lespérance; André Arsenault; Catherine Laurin; Nancy Frasure-Smith; Simon L Bacon
Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American heart journal     Volume:  148     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2004 Oct 
Date Detail:
Created Date:  2004-10-01     Completed Date:  2005-01-25     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  621-7     Citation Subset:  AIM; IM    
Affiliation:
Research Center, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada. kimlavoie@crhsc.umontreal.ca
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MeSH Terms
Descriptor/Qualifier:
Analysis of Variance
Blood Pressure
Coronary Disease / diagnosis,  psychology
Depressive Disorder, Major / complications*,  diagnosis,  physiopathology
Electrocardiography
Exercise Test*
Female
Heart Rate
Humans
Male
Middle Aged
Myocardial Ischemia / complications,  diagnosis*
Psychiatric Status Rating Scales
Tomography, Emission-Computed, Single-Photon

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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