title: Worsening of depressive symptoms 6 months after an acute coronary event in older adults is associated with impairment of cardiac autonomic function.
abstract: 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.
authors.affiliation: 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.
authors.forename: M Soledad Ladrón
authors.initials: MS
authors.lastname: de Guevara
authors.forename: Silvina I
authors.initials: SI
authors.lastname: Schauffele
authors.forename: Leonardo C
authors.initials: LC
authors.lastname: Nicola-Siri
authors.forename: Rodolfo D
authors.initials: RD
authors.lastname: Fahrer
authors.forename: Enrique
authors.initials: E
authors.lastname: Ortíz-Frágola
authors.forename: José A
authors.initials: JA
authors.lastname: Martínez-Martínez
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Cardinali
authors.forename: Salvador M
authors.initials: SM
authors.lastname: Guinjoan
mesh_terms: 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