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Depression Associated with Reduced Heart Rate Variability Predicts Outcome in Adult Congenital Heart Disease

In adult congenital heart disease (ACHD), major depressive disorder (MDD) represents a frequent comorbidity. In non-CHD, adverse outcome is predicted by MDD and heart rate variability (HRV), whereas in ACHD their prognostic relevance is unknown. We prospectively evaluated 171 patients (age 35.6 ± 11...

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Autores principales: Westhoff-Bleck, Mechthild, Lemke, Lars H., Bleck, Jan-Marc S., Bleck, Anja C., Bauersachs, Johann, Kahl, Kai G.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8067842/
https://www.ncbi.nlm.nih.gov/pubmed/33917168
http://dx.doi.org/10.3390/jcm10081554
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author Westhoff-Bleck, Mechthild
Lemke, Lars H.
Bleck, Jan-Marc S.
Bleck, Anja C.
Bauersachs, Johann
Kahl, Kai G.
author_facet Westhoff-Bleck, Mechthild
Lemke, Lars H.
Bleck, Jan-Marc S.
Bleck, Anja C.
Bauersachs, Johann
Kahl, Kai G.
author_sort Westhoff-Bleck, Mechthild
collection PubMed
description In adult congenital heart disease (ACHD), major depressive disorder (MDD) represents a frequent comorbidity. In non-CHD, adverse outcome is predicted by MDD and heart rate variability (HRV), whereas in ACHD their prognostic relevance is unknown. We prospectively evaluated 171 patients (age 35.6 ± 11.4 years; male 42.7%, mean observation time 54.7 ± 14.9 months). Binary regression analysis calculated the association between MDD and HRV. Cox proportional survival analysis estimated their impact on decompensated heart failure and all-cause mortality (HF/death), supraventricular and ventricular tachycardia (SVT/VT), and hospitalization due to unexpected cardiac causes. Exclusively MDD with moderate/severe symptoms showed significantly lower HRV as derived from frequency-domain analysis (Symindex) (p = 0.013). In multivariate Cox regression analysis, patients stratified according to the lower quartile of the Symindex comorbid with MDD (n = 16) exhibited poorer prognosis regarding HF/death (Hazard Ratio (HR): 7.04 (95%CI:(1.87–26.5)), SVT/VT (HR: 4.90 (95%CI:1.74–9.25)) and hospitalization (HR: 3.80 (95%CI:1.36–10.6)). An additional independent predictor was N-terminal pro-B-type natriuretic peptide elevation (p < 0.001), indicating advanced HF and heart disease complexity (p < 0.001). Autonomic nervous system dysfunction measured by altered HRV is considered to be one of the pathways linking MDD and adverse outcomes in cardiac diseases. Our results exceed the existing literature by demonstrating that MDD with decreased HRV is associated with poorer prognosis in ACHD.
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spelling pubmed-80678422021-04-25 Depression Associated with Reduced Heart Rate Variability Predicts Outcome in Adult Congenital Heart Disease Westhoff-Bleck, Mechthild Lemke, Lars H. Bleck, Jan-Marc S. Bleck, Anja C. Bauersachs, Johann Kahl, Kai G. J Clin Med Article In adult congenital heart disease (ACHD), major depressive disorder (MDD) represents a frequent comorbidity. In non-CHD, adverse outcome is predicted by MDD and heart rate variability (HRV), whereas in ACHD their prognostic relevance is unknown. We prospectively evaluated 171 patients (age 35.6 ± 11.4 years; male 42.7%, mean observation time 54.7 ± 14.9 months). Binary regression analysis calculated the association between MDD and HRV. Cox proportional survival analysis estimated their impact on decompensated heart failure and all-cause mortality (HF/death), supraventricular and ventricular tachycardia (SVT/VT), and hospitalization due to unexpected cardiac causes. Exclusively MDD with moderate/severe symptoms showed significantly lower HRV as derived from frequency-domain analysis (Symindex) (p = 0.013). In multivariate Cox regression analysis, patients stratified according to the lower quartile of the Symindex comorbid with MDD (n = 16) exhibited poorer prognosis regarding HF/death (Hazard Ratio (HR): 7.04 (95%CI:(1.87–26.5)), SVT/VT (HR: 4.90 (95%CI:1.74–9.25)) and hospitalization (HR: 3.80 (95%CI:1.36–10.6)). An additional independent predictor was N-terminal pro-B-type natriuretic peptide elevation (p < 0.001), indicating advanced HF and heart disease complexity (p < 0.001). Autonomic nervous system dysfunction measured by altered HRV is considered to be one of the pathways linking MDD and adverse outcomes in cardiac diseases. Our results exceed the existing literature by demonstrating that MDD with decreased HRV is associated with poorer prognosis in ACHD. MDPI 2021-04-07 /pmc/articles/PMC8067842/ /pubmed/33917168 http://dx.doi.org/10.3390/jcm10081554 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Westhoff-Bleck, Mechthild
Lemke, Lars H.
Bleck, Jan-Marc S.
Bleck, Anja C.
Bauersachs, Johann
Kahl, Kai G.
Depression Associated with Reduced Heart Rate Variability Predicts Outcome in Adult Congenital Heart Disease
title Depression Associated with Reduced Heart Rate Variability Predicts Outcome in Adult Congenital Heart Disease
title_full Depression Associated with Reduced Heart Rate Variability Predicts Outcome in Adult Congenital Heart Disease
title_fullStr Depression Associated with Reduced Heart Rate Variability Predicts Outcome in Adult Congenital Heart Disease
title_full_unstemmed Depression Associated with Reduced Heart Rate Variability Predicts Outcome in Adult Congenital Heart Disease
title_short Depression Associated with Reduced Heart Rate Variability Predicts Outcome in Adult Congenital Heart Disease
title_sort depression associated with reduced heart rate variability predicts outcome in adult congenital heart disease
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8067842/
https://www.ncbi.nlm.nih.gov/pubmed/33917168
http://dx.doi.org/10.3390/jcm10081554
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