Worsening of depressive symptoms 6 months after an acute coronary event in older adults is associated with impairment of cardiac autonomic function.
BACKGROUND
Depression increases mortality of coronary patients, and autonomic dysfunction has been proposed as an explanation for this association.


METHODS
In a sample of 38 adults > or = 60 years with myocardial infarction or unstable angina, we studied depression (presence of a major depressive episode and 21-item Hamilton depression score) and heart rate variability (HRV) of 550 normal beats shortly after admission to the coronary care unit (CCU). Thirty patients were alive at 6 months and were studied at that time as well. Spectral HRV measurements included power in the high-frequency range (HF, 0.15-0.55 Hz, a measure of parasympathetic activity) and low-frequency range (LF, 0.03-0.15 Hz). Nonspectral HRV measurements included standard deviation of normal beats (SDNN) and two measures of vagal activity: percentage of adjacent cycles differing by >50 ms (pNN50) and the root-mean-square of differences in successive beats (rMSNN).


RESULTS
Patients who died within 6 months (n=8) had a higher Hamilton-D score than survivors (13.9+/-6.5 vs. 18.4+/-5.6, P=0.039) and were more likely to have an episode of major depression upon admission to the CCU (71 vs. 27%, P=0.027). An increase in Hamilton-D score at 6 months correlated with a decrease in total (r=-0.48, P=0.014), high-frequency (r=-0.49, P=0.007), and low-frequency HRV (r=-0.46, P=0.014).


CONCLUSIONS
Patients belonged to a single institution and there was a small proportion of men.


CONCLUSIONS
Progression of mood symptoms 6 months after an acute coronary event is associated with an impairment of autonomic control of the heart in elderly individuals.
de Guevara
M Soledad Ladrón
MS
Dept. de Salud Mental, Hospital de Clínicas 'José de San Martín', Universidad de Buenos Aires, Ave. Córdoba 2351 5 degrees Piso, Buenos Aires 1120, Argentina.
Schauffele
Silvina I
SI
Nicola-Siri
Leonardo C
LC
Fahrer
Rodolfo D
RD
Ortíz-Frágola
Enrique
E
Martínez-Martínez
José A
JA
Cardinali
Daniel P
DP
Guinjoan
Salvador M
SM
D000208:Acute Disease; D000368:Aged; D001342:Autonomic Nervous System Diseases / Q000503:physiopathology*; D003327:Coronary Disease / Q000453:epidemiology* / Q000503:physiopathology*; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology*; D005500:Follow-Up Studies; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D008875:Middle Aged; D012720:Severity of Illness Index; D013997:Time Factors