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Dive into the research topics where Peter A. Shapiro is active.

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Featured researches published by Peter A. Shapiro.


The Lancet | 2001

Relation between depression after coronary artery bypass surgery and 12-month outcome: a prospective study

Ingrid Connerney; Peter A. Shapiro; Joseph S. McLaughlin; Emilia Bagiella; Richard P. Sloan

BACKGROUNDnThe association of depression with cardiac events has been investigated mainly in community cohorts, in patients undergoing catheterisation, or in patients who have had myocardial infarction. We have assessed the effect of depression on outcomes after coronary artery bypass graft (CABG) surgery.nnnMETHODSnIn a prospective study, we followed up for 1 year 207 men and 102 women, who had undergone coronary artery bypass graft surgery. We assessed depression with a structured psychiatric interview (diagnostic interview schedule) and a questionnaire (Beck depression inventory) before discharge. Cardiac events included angina or heart failure that needed admission to hospital, myocardial infarction, cardiac arrest, percutaneous transluminal coronary angioplasty, repeat CABG, and cardiac mortality. Non-cardiac events consisted of all other reasons for mortality or readmission.nnnFINDINGSn63 patients (20%) met modified diagnostic statistical manual IV criteria for major depressive disorder. At 12 months, 17 (27%) of these patients had a cardiac event compared with 25 of 246 (10%) who were not depressed (p<0.0008). Five variables had significant univariate associations with cardiac events: sex, living alone, low ejection fraction (<0.35), length of hospital stay, and depression. In a Cox proportional-hazard model with these five and two other variables of cardiac severity, major depressive disorder (risk ratio 2.3 [95% CI 1.17-4.56]), low ejection fraction (2.3 [1.07-5.03]), and female sex (2.4 [1.24-4.44]) were associated with adverse outcomes. Depression did not predict deaths or admissions for non-cardiac events.nnnINTERPRETATIONnDepression is an important independent risk factor for cardiac events after CABG surgery.


Transplantation | 1995

Psychosocial evaluation and prediction of compliance problems and morbidity after heart transplantation.

Peter A. Shapiro; Deborah L. Williams; Ann T. Foray; Ilene S. Gelman; Nicholas Wukich; Robert R. Sciacca

We examined prospectively determined psychosocial evaluation data in 125 consecutive adult patients undergoing heart transplantation from January 1992 to April 1994 to determine their associations with morbidity, mortality, and compliance. Prospective ratings included age, sex, weight, education, social support, living arrangements, motivation, knowledge and expectations about transplantation, intercurrent social stressors, substance abuse, personality disorder, cognitive impairment, other psychiatric disorders, and the evaluating psychiatrists global assessment of psychosocial risk. Additional variables evaluated were support group attendance and waiting list time. We examined outcomes including patient survival, compliance, episodes of rejection and infection, development of transplant coronary artery disease, number of missed appointments, and maintenance of ideal body weight. The posttransplant follow-up period was 13.8 +/- 9.9 months (mean +/- SD). In univariate analyses, compliance problems were associated with substance abuse history (P = .0007), personality disorder (P = .007), living arrangements (P = .02), and global psychosocial risk (P = .001). The number of rejection episodes was associated with global psychosocial risk (P = .029), and transplant coronary artery disease was inversely associated with education (P = .01). Survival was not associated with any of the predictor variables. In stepwise multivariate analyses, the significant predictors of compliance were substance abuse (odds ratio 3.69, confidence limits 1.07-12.71) and global psychosocial risk (odds ratio 3.76, confidence intervals 1.18-11.97). These findings suggest that pretransplant evaluation of psychosocial risk factors can identify patients with increased risk of postoperative noncompliance and morbidity.


American Journal of Cardiology | 1994

Cardiac autonomic control and hostility in healthy subjects

Richard P. Sloan; Peter A. Shapiro; J. Thomas Bigger; Emilia Bagiella; Richard C. Steinman; Jack M. Gorman

Abstract Disordered autonomic regulation of the cardiovascular system has been implicated in sudden cardiac death and coronary artery disease in numerous studies. Bigger et al 1 showed that survival after myocardial infarction was predicted by high-frequency (HF) power of the heart period power spectrum, a measure of vagal modulation of RR intervals, 2 by power in other frequency bands, and by the low-frequency (LF) to HF power ratio, a measure that has been used to estimate sympathovagal balance. Increased heart rate, reflecting global cardiac autonomic control, is associated with development of atherosclerosis in animal models 3 and age-adjusted levels of atherogenic lipoproteins in humans. 4 Heart rate-lowering interventions such as surgical ablation of the sinoatrial node and β-adrenergic antagonists have antiatherogenic effects. 3 Cardiovascular regulation by the autonomic nervous system may link negative personality characteristics, e.g., hostility, with increased risk of coronary artery disease, an association generally supported by available data. 5,6 Two views about the nature of the link, the constitutional and the transactional theories, specify different mechanisms. The constitutional theory holds that the autonomie activity associated with risk of coronary artery disease is caused by a constitutional characteristic which also accounts for hostility. 5 In this view, hostility is a marker of factors that influence brainstem cardioregulatory centers. The transactional theory holds that hostile persons interact with their environment in a way that creates interpersonal conflict and reduces social support. 5 Since in laboratory experiments, psychological Stressors decrease HF power in the heart period power spectrum, 7 the stressfulness of the transactions that persons high in hostility have with their interpersonal environments suggests an inverse relation between hostility and HF power, which in turn may increase risk of coronary artery disease.


Circulation | 2004

Neurological events during long-term mechanical circulatory support for heart failure ; the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) experience

Peter A. Shapiro; Brian E. Jaski; Michael K. Parides; Robert C. Bourge; John T. Watson; Laura Damme; Walter P. Dembitsky; Jeffrey D. Hosenpud; Lopa Gupta; Anita Tierney; Tonya Kraus; Yoshifumi Naka

Background—Progression of heart failure can lead to cardiac transplantation, but when patients are ineligible, long-term mechanical circulatory support may improve survival. The REMATCH trial showed that left ventricular assist devices (LVADs) prolonged survival in patients with end-stage disease, but with a significant number of adverse events. We report on the neurological outcomes in the REMATCH trial. Methods and Results—We examined new neurological events in the 129 patients randomized to either LVAD placement (n= 68) or medical management (n= 61), classified as stroke, transient ischemic attack, toxic-metabolic encephalopathy, and other. There were 46 neurological events: 42 in 30 LVAD patients and 4 in 4 patients in the medical arm (χ2, 30/68 versus 4/61, P < 0.001). Sixteen percent of the LVAD patients had a stroke, with a rate of 0.19 per year (95% CI, 0.10 to 0.33), many occurring in the postoperative period. The stroke rate in the medical arm was 0.052. A Kaplan-Meier survival analysis showed a 44% reduction in the risk of stroke or death in the LVAD group versus the optimal medical group (P = 0.002). The mean interval from implantation to stroke was 221.8 days (± 70.4 days). History of stroke, age, and sepsis were not stroke risk factors in the LVAD group. Conclusions—Fewer than half of the patients in the LVAD group had a neurological event, and there were few neurological deaths. Survival analysis combining stroke or death demonstrated a significant benefit for long-term circulatory support with an LVAD over medical therapy. Future trials will need to address prospectively all neurological outcomes, including neurocognitive function, and the role of long-term neuroprotection.


Biological Psychology | 1994

Effect of mental stress throughout the day on cardiac autonomic control

Richard P. Sloan; Peter A. Shapiro; Emilia Bagiella; S.M. Boni; M. Paik; J. T. Bigger; Richard C. Steinman; Jack M. Gorman

Although many laboratory studies have demonstrated changes in cardiac autonomic control during psychological stress, few have attempted to demonstrate this effect in ambulatory subjects. To address this issue, 24-h electrocardiographic recordings of 33 healthy subjects were analyzed for RR interval and heart period variability (HPV) responses associated with periodic diary entries measuring physical position, negative effect, and time of day. A total of 362 diary entries were made during the 24-h sessions, each in response to a device which signaled on an average of once per hour. HPV was analyzed in the frequency domain, yielding estimates of spectral power in low (LF) and high (HF) frequency bands, as well as the LF/HF ratio. Because of the high correlations of the measures of negative affect (alpha = 0.91), they were combined to create a single index of stress. Multivariate analysis was used to assess the effect of individual subject differences, physical position, and stress on RR interval and HPV. Results revealed significant effects of individual differences, stress, and physical position on RR interval, with increases in stress associated with decreases in RR interval as expected. HF power was significantly lower and the LF/HF ratio significantly higher in the standing compared with the sitting position. Psychological stress was significantly associated with an increase in the LF/HF ratio, suggesting increases in the relative predominance of sympathetic nervous system activity during stressful periods of the day. Overall, these findings suggest that in ambulatory normal subjects, cardiac autonomic control varies throughout the day as a function of self-reported stress.


American Heart Journal | 1999

An open-label preliminary trial of sertraline for treatment of major depression after acute myocardial infarction (the SADHAT Trial) ☆ ☆☆ ★

Peter A. Shapiro; François Lespérance; Nancy Frasure-Smith; Christopher M. O'Connor; Brian A. Baker; Jan Wei Jiang; Paul Dorian; Wilma Harrison; Alexander H. Glassman

BACKGROUNDnDepression occurs frequently in patients with acute myocardial infarction and is associated with increased mortality rates. It is not known whether serotonin reuptake inhibitors would be safe and effective for patients with depression after myocardial infarction and whether such treatment would reduce mortality rates.nnnMETHODS AND RESULTSnWe conducted a multicenter, open-label, pilot study of sertraline treatment in patients with major depressive disorder identified 5 to 30 days after admission for acute myocardial infarction. Outcome measures included cardiovascular and hemostatic function, adverse events, and mood ratings. Twenty-six patients were enrolled in the study. During treatment there were no significant changes in heart rate, blood pressure, cardiac conduction, or left ventricular ejection fraction, and there was a trend toward reduced ventricular ectopic activity. There were no changes in coagulation measures. Bleeding time increased in 12 patients, decreased in 4 patients, and was unchanged in 2 patients. Three (12%) patients withdrew from treatment prematurely because of adverse events. Significant improvements in mood ratings occurred over the course of treatment.nnnCONCLUSIONSnSertraline treatment was associated with clinical improvement and was well tolerated in >85% of the patients in this open-label treatment trial for patients with major depression after myocardial infarction. These results encourage further controlled trials to establish the effects of treatment for this high-risk population.


Psychosomatic Medicine | 1999

Cardiac autonomic control buffers blood pressure variability responses to challenge: a psychophysiologic model of coronary artery disease.

Richard P. Sloan; Peter A. Shapiro; Emilia Bagiella; Michael M. Myers; Jack M. Gorman

This article presents a model that identifies effects of blood pressure variability (BPV) as a possible mechanism by which psychological/psychiatric factors and health behaviors confer increased risk of coronary artery disease (CAD) and acute coronary syndromes. Recent research in vascular biology and dynamics of coronary artery blood flow suggests that BPV may have pathogenic effects on the coronary endothelium, plaque formation, and plaque stability. Thus, BPV may be a risk factor for cardiovascular disease independent of mean arterial pressure. The model proposes that autonomic control of the heart exerts a buffering or inhibitory influence on oscillations in blood pressure. Established psychological/behavioral risk factors for CAD, such as depression, hostility, and anxiety, as well as physical deconditioning and aging, are associated with diminished autonomic control of the heart, which may disinhibit pathogenic BPV. Together, these data suggest a coherent, testable psychophysiological model of CAD. In this article, we review these data and make recommendations for research to examine the model.


Psychosomatic Medicine | 1999

Hostility, Gender, and Cardiac Autonomic Control

Richard P. Sloan; Emilia Bagiella; Peter A. Shapiro; John P. Kuhl; Darya Chernikhova; Josh Berg; Michael M. Myers

Objective Although considerable evidence implicates hostility in the development of coronary artery disease (CAD), the pathogenic mechanisms remain poorly understood. We have developed a psychophysiological model that holds that altered autonomic nervous system function links psychological traits with CAD outcomes. In laboratory studies, stressors reduce high-frequency (HF) heart period variability, an index of cardiac vagal modulation. With ambulatory electrocardiographic recording, we demonstrated in a predominantly male sample that hostility was inversely associated with HF power, but only during waking hours. These findings are consistent with the hypothesis that hostile individuals experience multiple stressful interpersonal transactions each day, resulting in overall lower HF power during the day but not at night. Methods To further evaluate this hypothesis, we screened 96 subjects using the Cook-Medley Hostility Scale and selected 15 men and 15 women representing a wide distribution of hostility. These subjects were studied in a laboratory session assessing reactivity to psychological and orthostatic challenges with continuous electrocardiographic, blood pressure, and respiration monitoring. We predicted that for men and women, hostility would be inversely related to reductions in HF power in response to challenge. Results In response to mental stressors, all measures of heart period variability change were inversely related to hostility as predicted. No such relationships were found for responses to tilt. The data suggested a possible effect of gender on these relationships. Conclusions These data add to the growing body of evidence showing that hostility influences vagal modulation of the cardiovascular system and suggest that altered autonomic control is a pathogenic mechanism linking hostility and CAD.


Psychosomatic Medicine | 1996

Relationships between circulating catecholamines and low frequency heart period variability as indices of cardiac sympathetic activity during mental stress.

Richard P. Sloan; Peter A. Shapiro; Emilia Bagiella; J. T. Bigger; E. S. Lo; Jack M. Gorman

Heart rate increases during psychological stress are the product of cardiac sympathetic activation and parasympathetic withdrawal.Levels of plasma epinephrine (E) and norepinephrine (NE) have a long history as indicators of cardiac adrenergic activity and, accordingly, generally increase in response to psychological challenge. Recently, several investigators have suggested that indices derived from power spectral analysis of heart period variability (HPV) also may provide estimates of cardiac sympathetic nervous system activity. These indices include power in the low frequency band (0.04-0.15 Hz, LF), and the ratio of low to high frequency (0.15-0.50 Hz, HF) power (LF/HF). The relationship between spectral and neurohumoral indices during psychological stress has not been investigated. This issue was addressed by studying spectrally defined measures of HPV and levels of plasma E and NE in 34 normal subjects who participated in a study of responsiveness to a psychologically challenging arithmetic task.Heart rate (HR), LF and HF power, the LF/HF ratio, and blood pressure were measured during the 5-minute baseline and 5-minute task periods. Integrated samples of forearm venous blood were collected for both periods. E and NE were analyzed by high performance liquid chromatography. The task produced significant increases in HR, systolic and diastolic pressures, and NE. Of the 12 Pearson correlation coefficients used to examine the relationships between power spectral measures and catecholamines for the baseline, task, and delta values, none achieved statistical significance, suggesting little relationship between neurohumoral and spectral estimates of cardiac sympathetic activity. We conclude that under conditions of psychological stress, LF power provides no useful information about cardiac sympathetic activity, both because power in this frequency band falls whereas HR rises and because there is no relationship between LF power and plasma NE.


JAMA Internal Medicine | 2013

Centralized, Stepped, Patient Preference-Based Treatment for Patients With Post-Acute Coronary Syndrome Depression CODIACS Vanguard Randomized Controlled Trial

Karina W. Davidson; J. Thomas Bigger; Matthew M. Burg; Robert M. Carney; William F. Chaplin; Susan M. Czajkowski; Ellen Dornelas; Joan Duer-Hefele; Nancy Frasure-Smith; Kenneth E. Freedland; Donald C. Haas; Allan S. Jaffe; Joseph A. Ladapo; François Lespérance; Vivian Medina; Jonathan D. Newman; Gabrielle A. Osorio; Faith E. Parsons; Joseph E. Schwartz; Jonathan A. Shaffer; Peter A. Shapiro; David S. Sheps; Viola Vaccarino; William Whang; Siqin Ye

IMPORTANCEnControversy remains about whether depression can be successfully managed after acute coronary syndrome (ACS) and the costs and benefits of doing so.nnnOBJECTIVEnTo determine the effects of providing post-ACS depression care on depressive symptoms and health care costs.nnnDESIGNnMulticenter randomized controlled trial.nnnSETTINGnPatients were recruited from 2 private and 5 academic ambulatory centers across the United States.nnnPARTICIPANTSnA total of 150 patients with elevated depressive symptoms (Beck Depression Inventory [BDI] score ≥10) 2 to 6 months after an ACS, recruited between March 18, 2010, and January 9, 2012.nnnINTERVENTIONSnPatients were randomized to 6 months of centralized depression care (patient preference for problem-solving treatment given via telephone or the Internet, pharmacotherapy, both, or neither), stepped every 6 to 8 weeks (active treatment group; n = 73), or to locally determined depression care after physician notification about the patients depressive symptoms (usual care group; n = 77).nnnMAIN OUTCOME MEASURESnChange in depressive symptoms during 6 months and total health care costs.nnnRESULTSnDepressive symptoms decreased significantly more in the active treatment group than in the usual care group (differential change between groups, -3.5 BDI points; 95% CI, -6.1 to -0.7; P = .01). Although mental health care estimated costs were higher for active treatment than for usual care, overall health care estimated costs were not significantly different (difference adjusting for confounding, -

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Emilia Bagiella

NewYork–Presbyterian Hospital

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Donna Mancini

Icahn School of Medicine at Mount Sinai

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