Responses of Myocardial Ischemia to Sertraline Treatment

心肌缺血对舍曲林治疗的反应

• 批准号: 7491122
• 负责人: WEI JIANG
• 金额: $ 57.42万
• 依托单位: DUKE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2006
• 资助国家: 美国
• 起止时间: 2006-09-01 至 2012-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7491122
• 关键词: Affect; Age; Anxiety; Beck depression inventory; Binding; Blood Platelets; Blood Pressure; Blood Vessels; Cardiac; Cardiovascular Diseases; Cardiovascular system; Characteristics; Chronic; Clinical; Constriction procedure; Coronary; Coronary Angiography; Coronary Artery Bypass; Coronary Stenosis; Daily; Diastolic blood pressure; Doctor of Medicine; Dose; Double-Blind Method; Echocardiography; Event; Exercise; Exercise stress test; Future; Goals; Heart Diseases; Heart Rate; Heart failure; Hostility; Intervention; Ischemia; Laboratories; Left; Left Ventricular Ejection Fraction; Left Ventricular Function; Left ventricular structure; Life; Major Depressive Disorder; Measures; Mental Depression; Modality; Modification; Motion; Myocardial Infarction; Myocardial Ischemia; Myocardium; Operative Surgical Procedures; Outcome; Participant; Patients; Pharmaceutical Preparations; Placebo Control; Placebos; Platelet aggregation; Procedures; Protocols documentation; Psyche structure; Purpose; Randomized; Recording of previous events; Research Personnel; Rest; Risk; Risk Factors; Role; Score; Selective Serotonin Reuptake Inhibitor; Series; Serotonin; Sertraline; Severities; Standards of Weights and Measures; Stress; Stress Tests; Sum; Therapeutic; Upper arm; Vascular blood supply; Ventricular; Week; depressive symptoms; improved; outcome forecast; programs; response; stress management; treatment effect; uptake; week trial

DESCRIPTION (provided by applicant): Myocardial ischemia, an important measure of the clinical activity of ischemic heart disease (IHD), occurs when the myocardium does not receive enough blood supply resulting from either coronary constriction or high demand or both. Mental stress has been shown to be a trigger inducing myocardial ischemia. Mental stress-induced myocardial ischemia (MSIMI) is suggested due to reduction of coronary blood supply rather than increased myocardium demand. MSIMI is clinically important as to its high predictability for increased adverse cardiac events. Despite this, no pharmacological modalities have been proven to improve MSIMI. Previous studies suggest stress management and exercise may be beneficial. Depression, a particularly prevalent problem in patients with cardiovascular diseases, is proven to be a risk factor for increased adverse cardiac outcomes in patients with IHD, independent of conventional cardiac risks. Our recent study demonstrated that depression symptoms were associated with increased likelihood of MSIMI, which is possibly an underlying mechanism of depression adversely affect the prognosis of IHD. It has been suggested that selective serotonin reuptake inhibitors (SSRIs) may improve cardiac outcome which may not be related to improvement of depression. One mechanism of SSRIs that may be cardiac protective is related to their ability of reducing platelet activity. The proposed project plans to investigate the response of MSIMI to sertraline compared to placebo. Further, it plans to determine whether the modification of MSIMI is related to improvement of depression symptoms, cardiovascular reactivity to stress, and/or of platelet aggregation. To achieve these goals, we propose a randomized, placebo-controlled single center study using sertraline versus placebo for clinically stable IHD patients with MSIMI. A total of 120 IHD patients with MSIMI will be equally randomized into sertraline or placebo for 6 weeks. Ischemic activity during mental stress and exercise testing, cardiovascular reactivity, platelet activity, depression, anxiety, hostility, and level of perceived stress will be assessed at baseline and at the end of the 6-week intervention. This study will improve the outcome of IHD patients by helping us to better understand how successful the treatment of sertraline affects the cardiovascular system.

描述（由申请人提供）：心肌缺血是缺血性心脏病（IHD）的重要度量，当心肌没有获得足够的血液供应而导致冠状动脉收缩或高需求或两者兼有的血液供应时，就会发生。精神压力已被证明是诱导心肌缺血的触发因素。由于冠状动脉血液供应减少而不是心肌需求增加，建议精神应激诱导的心肌缺血（MSIMI）。 MSIMI在临床上对增加心脏不良事件的高可预测性在临床上很重要。尽管如此，尚未证明没有药理方式可以改善MSIMI。先前的研究表明，压力管理和运动可能是有益的。抑郁症是心血管疾病患者特别普遍的问题，被证明是增加IHD患者不良心脏结局的危险因素，与常规心脏风险无关。我们最近的研究表明，抑郁症状与MSIMI的可能性增加有关，这可能是抑郁症的潜在机制对IHD的预后产生不利影响。已经提出，选择性5-羟色胺再摄取抑制剂（SSRI）可能会改善心脏预后，这可能与抑郁症的改善无关。 SSRI的一种可能是心脏保护性的机制与它们减少血小板活性的能力有关。拟议的项目计划与安慰剂相比，研究MSIMI对舍曲林的反应。此外，它计划确定MSIMI的修饰是否与抑郁症状的改善，对压力的心血管反应性和/或血小板聚集有关。为了实现这些目标，我们提出了一项随机的，安慰剂对照的单中心研究，使用舍曲林与安慰剂，用于临床稳定的MSIMI患者。共有120名MSIMI患者将同样随机分为舍曲林或安慰剂6周。精神压力和运动测试，心血管反应性，血小板活动，抑郁，焦虑，敌意和感知压力水平的缺血活动将在基线和6周的干预结束时进行评估。这项研究将通过帮助我们更好地了解舍曲林的治疗如何影响心血管系统，从而改善IHD患者的结果。