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Responses of Myocardial Ischemia to Escitalopram Treatment

Information source: Duke University
ClinicalTrials.gov processed this data on August 23, 2015
Link to the current ClinicalTrials.gov record.

Condition(s) targeted: Myocardial Ischemia

Intervention: Escitalopram (Drug); Placebo (Drug)

Phase: Phase 4

Status: Completed

Sponsored by: Duke University

Official(s) and/or principal investigator(s):
Wei Jiang, M.D., Principal Investigator, Affiliation: Duke University


Depression is commonly seen in patients with cardiovascular disorders. In recent studies it has been shown that mild to moderate depression symptoms were associated with increased likelihood of mental stress-induced myocardial ischemia (MSIMI), which is a risk factor of poor cardiac outcome. In this project, the investigators aim to assess the treatment of mental stress-induced myocardial ischemia in ischemic heart disease patients with mild to moderate depressive symptoms. This study is a six-week double-blind placebo controlled study to examine the effects of escitalopram on mental stress-induced myocardial ischemia. This study will look to show that patients with ischemic heart disease who are treated with escitalopram will exhibit a significant improvement of MSIMI at the end of week 6 compared to patients receiving placebo.

Clinical Details

Official title: Responses of Myocardial Ischemia to Escitalopram Treatment (REMIT Trial)

Study design: Allocation: Randomized, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Caregiver, Investigator, Outcomes Assessor), Primary Purpose: Treatment

Primary outcome:

Percentage of Participants With an Absence of Mental Stress-induced Myocardial Ischemia (MSIMI) During the 3 Mental Stressors

Percentage of Participants With Overall Mental Stress-induced Myocardial Ischemia (MSIMI)

Secondary outcome:

Mental Stress Induced Change of Systolic Blood Pressure

Mental Stress Induced Change of Diastolic Blood Pressure

Percentage of Participants With Adverse Events

Beck Depression Inventory

Mental Stress Induced Change in Heart Rate

5HTT, Serotonin Transporter Protein

Platelet Serotonin Binding Affinity Kd_100

Perceived Stress Scale

Cook-Medley Hostility (Ho) Scale

Cook-Medley Hostility (Ho) Hostile Affect Sub-scale

Spielberger State-Trait Anxiety Inventory Scales (STAI)

Exercise Stressed-induced Myocardial Ischemia (ESIMI)

Detailed description: The goals of this project are to investigate the response of mental stress-induced myocardial ischemia (MSIMI) to escitalopram, a selective serotonin reuptake inhibitor (SSRI); to determine whether MSIMI will be reduced by the treatment, and whether the modification of MSIMI is related to improvement of depression symptoms, and/or the reduction of platelet aggregation, and/or the reduction of cardiovascular reactivity. This is a randomized study using escitalopram versus placebo for stable ischemic heart disease patients with MSIMI. This study will also explore the role of platelet activity in occurrence with MSIMI and other characteristics of MSIMI, such as systolic and diastolic function of the left ventricle during mental stress testing as compared to exercise testing. The stress testing will be conducted at the Duke Cardiology Diagnostic Unit Laboratory. Following a 20-minute calibration-rest period, participants will be asked to complete a series of 3 mental stress tasks. There are 3 mental stress tasks to be used for this study, i. e., (1) Mental arithmetic: during this test, patients will be asked to perform a series of serial subtractions beginning at a given number which will be different for each repeated test and will be chosen by the tester from a fixed list of various numbers, with encouragement to perform calculations as quickly as possible; (2) Public speaking with anger recall: during this test, patients will be asked to give a speech on a recent situation in which they experienced anger to an audience of observers (two to three) after 1 minute of preparation. Prior to the speech, subjects are told that their speech will be evaluated on their description of the situation, as to what happened, what they thought, felt, what they did, and what happened as a result. If they run out of things to say, the research tech will prompt them with questions to elicit more content until the three minutes are up; (3) Mirror trace: during this test, patients will be asked to outline, as quickly as possible, a star from its reflection in a mirror. Each task will last 3 minutes and there will be a 6-minute rest period between tasks.


Minimum age: 21 Years. Maximum age: 90 Years. Gender(s): Both.


Inclusion Criteria:

- Age 21 or greater, less than 90

- Stable ischemic heart disease

Exclusion Criteria:

- Recent myocardial infarction, coronary artery bypass graft surgery, or other

revascularization procedures (less than 3 months ago)

- Left ventricular ejection fraction(LVEF) < 15% measured by echocardiography,

radionuclide ventriculography (RNV), or cardiac catheterization

- Life threatening arrhythmia or arrhythmia interrupting the interpretation of ischemia

- Unable to withdraw from anti-anginal medications during ischemic assessment phase

- Unable to perform exercise testing

- Pregnancy

- Current or previous history of bipolar disorder, cyclothymia, schizophrenia,

schizoaffective or schizophreniform disorder, or other psychotic disorders

- Active suicidal ideation

- Current substance abuse or history of substance abuse in the previous 6 months

- Significant cardiac, pulmonary, metabolic, renal, hepatic disease, or malignancy,

interfering with patient's participation in this study

- Seizure (history and/or present) with/without treatment

- Currently taking antidepressants that cannot be discontinued

Locations and Contacts

Duke University Medical Center, Durham, North Carolina 27710, United States
Additional Information

Related publications:

Jiang W, Velazquez EJ, Samad Z, Kuchibhatla M, Martsberger C, Rogers J, Williams R, Kuhn C, Ortel TL, Becker RC, Pristera N, Krishnan R, O'Connor CM. 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. Am Heart J. 2012 Jan;163(1):20-6. doi: 10.1016/j.ahj.2011.09.018. Epub 2011 Nov 14.

Starting date: September 2006
Last updated: July 8, 2015

Page last updated: August 23, 2015

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