Intracranial Atherosclerosis and predictors of Post-CABG Depression

描述（由申请人提供）：冠状动脉旁路移植术（CABG）术后抑郁是常见的（高达40%），并且在第一年增加心脏发病率和死亡率的风险超过两倍。然而，目前关于冠状动脉搭桥后抑郁症发病机制的数据缺乏，阻碍了冠状动脉搭桥后抑郁症预防或治疗策略的发展。“血管性抑郁”假说认为，脑血管疾病使迟发性抑郁易感、沉淀或延续，并涉及不同于特发性早发性抑郁的发病机制和治疗策略。cabg后抑郁和血管性抑郁在人口统计学、纵向病程和血管危险因素方面存在显著的相似性。在这篇修订后的申请中，这位新的R01研究者提出了一项前瞻性队列研究，利用经颅多普勒超声（TCD）检测和量化颅内动脉粥样硬化（ICA）的位置和严重程度，并评估其他可能的CABG前危险因素（如CABG前抑郁、神经质、低社会和低支持）对200名CABG手术患者在心导管置入时的CABG后抑郁。然后我们将在随后的12个月里对受试者进行随访，以评估cabg后抑郁的发生率、症状和病程。我们预测，通过TCD评估的ICA术前负担将是cabg后抑郁的一个强大的独立危险因素，其特征和症状（如发病年龄晚、执行功能障碍、功能障碍、冷漠和快感缺乏）将与“血管抑郁”假说相一致。证实这些预测将支持cabg后抑郁是血管性抑郁的一种形式的假设，从而为使用移动床边工具进行风险分层和开发基于病因的预防策略奠定基础，以降低与cabg后抑郁相关的发病率和死亡率。

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.