Responses of mental stress–induced myocardial ischemia to escitalopram treatment: Background, design, and method for the Responses of Mental Stress Induced Myocardial Ischemia to Escitalopram Treatment trial

• Published in: The American heart journal Vol. 163; no. 1; pp. 20 - 26
• Main Authors: Jiang, Wei, MD, Velazquez, Eric J., MD, Samad, Zainab, MD, Kuchibhatla, Maragatha, PhD, Martsberger, Carolyn, PhD, Rogers, Joseph, MD, Williams, Redford, MD, Kuhn, Cynthia, PhD, Ortel, Thomas L., MD, PhD, Becker, Richard C., MD, Pristera, Nicole, Krishnan, Ranga, MD, O'Connor, Christopher M., MD, FACC
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 2012; Mosby; Elsevier Limited
• Subjects: Acquisitions & mergers; Adult; Biological and medical sciences; Blood platelets; Cardiology. Vascular system; Cardiovascular; Cardiovascular disease; Cardiovascular Diseases - drug therapy; Cardiovascular Diseases - mortality; Cardiovascular Diseases - psychology; Citalopram - administration & dosage; Coronary heart disease; Coronary vessels; Depressive Disorder - complications; Depressive Disorder - drug therapy; Drug dosages; Drug therapy; Exercise Test; Heart; Heart attacks; Heart surgery; Humans; Ischemia; Laboratories; Medical sciences; Myocardial Infarction - drug therapy; Myocardial Infarction - mortality; Myocardial Infarction - psychology; Myocarditis. Cardiomyopathies; Psychometrics; Research Design; Serotonin Uptake Inhibitors - administration & dosage; Stress; Stress, Psychological - complications; Stress, Psychological - drug therapy; Studies; Treatment Outcome; Veins & arteries; Escitalopram; Myocardial ischemia; Cardiovascular disease; Method; Coronary heart disease; Myocardial disease; Stress; Vascular disease; Design; Response; Treatment; Circulatory system; Technique; Cardiology
• ISSN: 0002-8703; 1097-6744
• DOI: 10.1016/j.ahj.2011.09.018

Background Mental stress–induced myocardial ischemia (MSIMI) is common in patients with clinically stable coronary heart disease (CHD) and is associated with poor outcomes. Depression is a risk factor of MSIMI. The REMIT trial investigates whether selective serotonin reuptake inhibitor (SSRI) treatment can improve MSIMI. The rationale and outline of the study are described. Method In this single-center randomized clinical trial, adult patients with clinically stable CHD are recruited for baseline mental and exercise stress testing assessed by echocardiography. In addition, psychometric questionnaires are administered, and blood samples are collected for platelet activity analysis. Patients who demonstrate MSIMI, defined by new abnormal wall motion, ejection fraction reduction ≥8%, and/or development of ischemic ST change in electrocardiogram during mental stress testing, are randomized at a 1:1 ratio to escitalopram or placebo for 6 weeks. Approximately 120 patients with MSIMI are enrolled in the trial. The stress testing, platelet activity assessment, and psychometric questionnaires are repeated at the end of the 6-week intervention. The hypothesis of the study is that SSRI treatment improves MSIMI via mood regulation and modification of platelet activity. Conclusion The REMIT study examines the effect of SSRI on MSIMI in vulnerable patients with CHD and probes some potential underlying mechanisms.