Intracranial Atherosclerosis and predictors of Post-CABG Depression

颅内动脉粥样硬化和 CABG 术后抑郁的预测因子

• 批准号: 8251171
• 负责人: HOCHANG B LEE
• 金额: $ 45.64万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-01 至 2015-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8251171
• 关键词: Affect; Age of Onset; Anhedonia; Blood Flow Velocity; Blood Vessels; Cardiac; Cardiac Catheterization Procedures; Caregivers; Cerebrovascular Circulation; Cerebrovascular Disorders; Cohort Studies; Comorbidity; Coronary Arteriosclerosis; Coronary Artery Bypass; Data; Development; Diagnostic; Disease; Doppler Ultrasound; Early Diagnosis; Family history of; Foundations; Functional disorder; Gender; Impairment; Incidence; Interview; Intracranial Atheroscleroses; Location; Major Depressive Disorder; Measures; Medical; Mental Depression; Morbidity - disease rate; NIH Program Announcements; Neurotic Disorders; Operative Surgical Procedures; Patients; Postoperative Period; Prevention; Prevention strategy; Procedures; Psyche structure; Public Health; Recording of previous events; Relative Risks; Research; Research Personnel; Risk; Risk Factors; Severities; Social support; Socioeconomic Status; Stratification; Structure; Technology; Testing; Time; Validity and Reliability; base; demographics; early onset; executive function; functional decline; functional disability; intracranial artery; longitudinal course; middle cerebral artery; minor depressive disorder; mortality; prospective; public health relevance; response; tool development; treatment strategy; vascular depression

DESCRIPTION (provided by applicant): Depression after coronary artery bypass graft (CABG) surgery is common (up to 40%) and increases risk of cardiac morbidity and mortality in the first year by more than two fold. However, current scarcity of data on etiopathogenesis of post-CABG depression hampers development of prevention or treatment strategies of post-CABG depression. "Vascular Depression" hypothesis posits that cerebrovascular disease predisposes, precipitates, or perpetuates late-onset depression and implicates etiopathogenesis and treatment strategies that are different from idiopathic, early-onset depression. Conspicuous similarities in demographics, longitudinal course, and presence of vascular risk factors exist between post-CABG depression and vascular depression. In this revised application this new R01 investigator proposes a prospective cohort study that utilizes Transcranial Doppler ultrasound (TCD) to detect and quantify the location and severity of Intracranial Atherosclerosis (ICA), as well as to assess for other putative pre-CABG risk factors (e.g. pre-CABG depression, neuroticism, low social and support) for post-CABG depression in 200 CABG surgery patients at the time of cardiac catheterization. We will then follow the subjects over the subsequent 12 months to assess for incidence, symptomatology and course of post-CABG depression. We predict that pre-operative burden of ICA, as assessed by TCD, will be a strong independent risk factor for post-CABG depression, and that features and symptomatology (e.g. late age of onset, executive dysfunction, functional impairment, apathy and anhedonia) will be consistent with the "Vascular Depression" Hypothesis. Confirming these predictions will support the hypothesis that post-CABG depression is a form of Vascular Depression, thus laying the foundation for risk stratification with a mobile, bedside tool and development of etiologically-based prevention strategies to reduce morbidity and mortality associated with post-CABG depression. PUBLIC HEALTH RELEVANCE: Depression after coronary artery bypass graft (CABG) surgery is a significant public health problem with serious consequences for patients and caregivers. Prevention and early diagnosis of depression after CABG surgery is a major priority in managing patients. Testing the "Vascular Depression" hypothesis and identifying reliable risk factors for post-CABG depression could lay the foundation for the development of etiologically-based risk stratification and prevention strategies to reduce morbidity and mortality associated with post-CABG depression.

描述（由申请人提供）：冠状动脉旁路移植术（CABG）术后抑郁很常见（高达40%），第一年心脏病发病率和死亡率的风险增加了两倍以上。然而，目前缺乏关于CABG后抑郁症发病机制的数据，阻碍了CABG后抑郁症预防或治疗策略的发展。 “血管性抑郁症”假说认为，脑血管疾病易诱发、促成或延续晚发性抑郁症，其发病机制和治疗策略与特发性早发性抑郁症不同。CABG后抑郁症和血管性抑郁症在人口统计学、纵向病程和血管危险因素方面存在明显的相似性。 在这项修订后的申请中，这位新的R 01研究者提出了一项前瞻性队列研究，该研究利用经颅多普勒超声（TCD）来检测和量化颅内动脉粥样硬化（伊卡）的位置和严重程度，并评估其他推定的冠状动脉旁路移植术前风险因素在200例CABG手术患者中，在心导管插入术时，对CABG术后抑郁（例如，CABG前抑郁、神经质、低社交和支持）进行了评估。然后，我们将在随后的12个月内对受试者进行随访，以评估CABG后抑郁的发生率、病理学和病程。 我们预测经TCD评估的伊卡术前负荷将是CABG后抑郁的一个强有力的独立危险因素，并且特征和病理学（例如，发病年龄晚、执行功能障碍、功能障碍、情感淡漠和快感缺乏）将与“血管性抑郁”假说一致。阐明这些预测将支持CABG后抑郁是血管性抑郁的一种形式的假设，从而为使用移动的床边工具进行风险分层和制定基于病因的预防策略以降低CABG后抑郁相关的发病率和死亡率奠定基础。 公共卫生关系：冠状动脉旁路移植术（CABG）后抑郁症是一个重要的公共卫生问题，对患者和护理人员造成严重后果。预防和早期诊断冠状动脉旁路移植术后抑郁症是管理患者的主要优先事项。验证“血管性抑郁”假说并确定CABG后抑郁的可靠危险因素，可以为制定基于病因的风险分层和预防策略奠定基础，以降低CABG后抑郁相关的发病率和死亡率。