Effects of a Mental Stress Challenge on Brain Function in Coronary Artery Disease Patients With and Without Depression

• Type of Material: Article
• Authors: J. Douglas Bremner, Emory University; Negar Fani, Emory University; Faiz A. Cheema, Emory University; Ali Ashraf, Emory University; Viola Vaccarino, Emory University
• Language: English
• Date: 2019-10-01
• Publisher: AMER PSYCHOLOGICAL ASSOC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019, American Psychological Association
• Final Published Version (URL): http://dx.doi.org/10.1037/hea0000742
• Title of Journal or Parent Work: HEALTH PSYCHOLOGY
• Volume: 38
• Issue: 10
• Start Page: 910
• End Page: 924
• Grant/Funding Information: This study was supported by the Charles A. Dana Foundation and NIH research grants to JDB R01 HL088726, K24 MH076955, T32 MH067547–01, and R01 MH56120. VV receives research funding support from NIH R01 HL66287–01 and Aetna Health Foundation.
• Keywords: PSYCHOSOMATIC-MEDICINE; NORADRENERGIC MECHANISMS; HEART-DISEASE; Social Sciences; Psychology; brain function; AUTONOMIC NERVOUS-SYSTEM; SEX-DIFFERENCES; positron emission tomography; BLOOD-PRESSURE; INDUCED-MYOCARDIAL-ISCHEMIA; add anterior cingulate; Psychology, Clinical; ANTERIOR CINGULATE CORTEX; coronary artery disease; CARDIOVASCULAR AROUSAL; MAJOR DEPRESSION

Abstract

Objective: Coronary artery disease (CAD) patients with comorbid depression show an increase in mortality compared to cardiac patients without depression, but the mechanisms mediating this effect remain obscure. One possible explanation for this finding is that depressed patients with CAD exhibit an increased vulnerability to stress. The purpose of this study was to assess the effects of stress and depression on brain function and to explore its relationship with myocardial ischemia in CAD patients. Methods: Patients with CAD and depression (N = 13) and CAD without depression (N = 15) underwent imaging of the brain with positron emission tomography and [O-15] water and imaging of the heart with single photon emission computed tomography (SPECT) and [Tc-99m] sestamibi under mental stress task and control conditions. Results: CAD patients with depression compared to nondepressed showed decreased function with mental stress in the rostral anterior cingulate, the hippocampus, parts of the dorsolateral temporal and parietal cortex, the cerebellum, and the uncus, with increased blood flow in the parahippocampus, visual association cortex, and posterior cingulate. Depressed CAD patients who became ischemic during a mental stress task had relative decreases in the caudal and posterior cingulate, orbitofrontal cortex, and cerebellum, and increased activation in the parietal cortex and precuneus/visual association cortex compared to nonischemic depressed CAD patients. Conclusions: These findings are consistent with dysfunction in a network of brain regions involved in the stress response in patients with comorbid CAD and depression that has direct and indirect links to the heart, suggesting a pathway by which stress and depression could lead to increased risk of heart disease related morbidity and mortality.