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Are exercise stress tests appropriate for assessing myocardial ischemia in patients with major depressive disorder?

Kim L Lavoie1, Richard P Fleet, Francois Lespérance

  • 1Research Center, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada. kimlavoie@crhsc.umontreal.ca

American Heart Journal
|October 2, 2004
PubMed

Insights

Major depressive disorder (MDD) in coronary artery disease (CAD) patients impairs exercise performance. Electrocardiography (ECG) may be less reliable than SPECT for detecting ischemia in depressed individuals.

Area of Science:

  • Cardiology
  • Psychiatry
  • Medical Diagnostics

Background:

  • Major depressive disorder (MDD) is prevalent in coronary artery disease (CAD) patients.
  • MDD symptoms can impact exercise tolerance and ischemia detection during stress tests.
  • Accurate ischemia detection is crucial for CAD prognosis.

Purpose of the Study:

  • To investigate how MDD and depressive symptoms affect exercise test performance.
  • To compare the diagnostic accuracy of ECG versus SPECT for ischemia detection in MDD patients with CAD.

Main Methods:

  • 1367 consecutive patients undergoing exercise testing were assessed.
  • Patients completed the Beck Depression Inventory (BDI) and a psychiatric interview (PRIME-MD).
  • Exercise test performance (e.g., %MPHR, peak exercise mets) and ischemia detection (ECG vs. SPECT) were analyzed.

Main Results:

  • 13% of patients had MDD.
  • MDD patients showed significantly lower exercise performance (%MPHR, peak mets, duration).
  • SPECT showed similar ischemia rates in MDD and non-MDD groups, while ECG showed significantly lower rates in MDD patients.

Conclusions:

  • MDD and depressive symptoms are associated with poor exercise tolerance in CAD patients.
  • ECG may underestimate ischemia in depressed patients compared to SPECT.
  • These findings highlight the need for careful consideration of depressive status in cardiac stress testing.
Abstract

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