Prospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Apr 6, 2020; 8(7): 1232-1240
Published online Apr 6, 2020. doi: 10.12998/wjcc.v8.i7.1232
Depression and myocardial injury in ST-segment elevation myocardial infarction: A cardiac magnetic resonance imaging study
Zhao-Qing Sun, Tong-Tong Yu, Yue Ma, Quan-Mei Ma, Yun-Di Jiao, Dong-Xu He, Jia-KeWu, Zong-Yu Wen, Xiao-Nan Wang, Yang Hou, Zhi-Jun Sun
Zhao-Qing Sun, Tong-Tong Yu, Yun-Di Jiao, Dong-Xu He, Jia-KeWu, Zong-Yu Wen, Zhi-Jun Sun, Department of Cardiology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China
Yue Ma, Quan-Mei Ma, Xiao-Nan Wang, Yang Hou, Department of Radiology, Shenyang 110004, Liaoning Province, China
Author contributions: Sun ZQ designed the study and wrote the paper; Sun ZJ designed the study and revised the paper; Jiao YD, He DX, Wu JK, and Wen ZY collected the patient’s clinical data; Yu TT analyzed the data; Wang XN performed the CMR for the patients; Ma Y and Ma QM performed the CMR analyses; Hou Y verified the CMR results.
Supported by the National Key R& D Program of China, No. 2018YFC1311600.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of the Shengjing Hospital of China Medical University Research Ethics Committee (No.2016PS373K).
Clinical trial registration statement: This study is registered at ClinicalTrials.gov. The registration identification number is No. 2016PS373K.
Informed consent statement: Abandoned specimens and clinical data were used in this study, which had no effect on the routine diagnosis and treatment of patients. Patients signed informed consent via fingerprint on an electronic form that was part of the hospital electronic information management system during hospitalization.
Conflict-of-interest statement: The authors declare no conflicts of interest.
Data sharing statement: The data used to support the findings of this study are available from the corresponding author upon request.
CONSORT 2010 statement: The authors have read the CONSORT 2010 statement, and the manuscript was prepared and revised according to the CONSORT 2010 statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Zhi-Jun Sun, MD, PhD, Professor, Director, Department of Cardiology, Shengjing Hospital of China Medical University, 36 Sanhao Street, Heping District, Shenyang 110004, Liaoning Province, China. sunzj@sj-hospital.org
Received: December 21, 2019
Peer-review started: December 21, 2019
First decision: January 17, 2020
Revised: February 25, 2020
Accepted: March 9, 2020
Article in press: March 9, 2020
Published online: April 6, 2020
Processing time: 106 Days and 23.4 Hours
ARTICLE HIGHLIGHTS
Research background

Patients with myocardial infarction (MI) have a high prevalence of depression, which is related to poor prognosis. However, the detailed pathophysiology of this relationship is still unsubstantiated. Cardiac magnetic resonance (CMR) is the gold standard for quantifying post-MI myocardial injury. The Patient Health Questionnaire-9 (PHQ-9) could assess the presence and severity of depressive symptoms and has reasonable sensitivity and specificity for patients with MI. Revealing the pathological mechanisms underlying the association of depression with adverse clinical outcomes is still a main area of prognostic study of the cardiovascular field.

Research motivation

CMR is the gold standard for quantifying post-MI myocardial injury. Revealing the association between depression and myocardial injury measured on CMR may facilitate the detection of high-risk patients with MI and thereby improve the prognosis of patients.

Research objectives

This study aimed to assess the association between depression identified by the PHQ-9 and myocardial injury measured on CMR in patients with ST-segment elevation myocardial infarction (STEMI).

Research methods

A total of 107 STEMI patients undergoing primary percutaneous coronary intervention (P-PCI) were analyzed in this prospective cohort study. Each subject completed a PHQ-9 to assess the presence and severity of depressive symptoms. CMR was performed at a median of 3 d after P-PCI for quantifying post-MI myocardial injury. Correlations between depression identified by PHQ-9 and myocardial injury measured on CMR were assessed.

Research results

The PHQ-9 was significantly predictive of large infarct size, and the major depression group had a substantially higher large infarct risk. The PHQ-9 score had a significant positive correlation with CMR-related variables of infarction size and area at risk.

Research conclusions

In patients with STEMI undergoing PCI, depression was independently associated with a large infarction size. The PHQ-9 may also help us assess myocardial injury in patients with STEMI.

Research perspectives

The results of this study provide evidence of a new pathological link to support the association of depression with adverse clinical outcomes of myocardial injury. In the future, more subjects should be incorporated to further confirm the results of this study. Mental health should be emphasized for cardiovascular disease patients. More importantly, cardiovascular physicians and psychologist should unite to fight against these diseases.