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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...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
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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. |
format | Online Article Text |
id | pubmed-8067842 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
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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