title: Cardiac-related hospitalization and/or death associated with immune dysregulation and symptoms of depression in heart failure patients.
abstract: OBJECTIVE
  Congestive heart failure (CHF) patients with depressive symptoms have a greater risk of morbidity and mortality. Immune activity such as inflammation is increasingly implicated as underlying this relationship. However, it is unknown whether there is a broader spectrum of immune dysregulation beyond inflammatory activity. This study examined in CHF patients the relationship of depressive symptoms with cellular immune activity measured by Th1/Th2 ratios and cardiac rehospitalization and/or death.
  
  
  METHODS
  Eighteen patients with CHF (mean age = 62, NYHA classes II-IV) were enrolled and depressive symptoms were measured with interviewer ratings using the Hamilton Rating Scale-Depression. For the determination of Th1/Th2 ratios, intracellular cytokine expression of interferon-gamma (IFN-gamma) and interleukin-10 (IL-10) CD4+ T cells were measured by flow cytometry. Plasma interleukin-6 levels were measured to ascertain circulating inflammatory cytokine activity. Patient records were examined for cardiac related rehospitalization or cardiac related death over a two-year period after baseline depression and immune measures were taken.
  
  
  RESULTS
  Higher depression scores were associated with a prospective increase in incidence of cardiac related hospitalizations and/or death (p = .037). Lesser IFN-gamma/IL-10 expressing CD4+ T cell ratios were related to higher depressive symptom scores at baseline (p = .005) and a prospective increased incidence of cardiac related hospitalization or death over a two-year period (p = .05).
  
  
  CONCLUSIONS
  A shift in the Th1/Th2 ratio may play a role in the association between depressive symptoms and morbidity and mortality in CHF patients, suggesting broader immune dysregulation than previously considered.
authors.affiliation: Department of Medicine, University of California, San Diego, CA, USA. lredwine@vapop.ucsd.edu
authors.forename: Laura S
authors.initials: LS
authors.lastname: Redwine
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Mills
authors.forename: Suzi
authors.initials: S
authors.lastname: Hong
authors.forename: Thomas
authors.initials: T
authors.lastname: Rutledge
authors.forename: Veronica
authors.initials: V
authors.lastname: Reis
authors.forename: Alan
authors.initials: A
authors.lastname: Maisel
authors.forename: Michael R
authors.initials: MR
authors.lastname: Irwin
mesh_terms: D000368:Aged; D016207:Cytokines / Q000097:blood; D003863:Depression / Q000276:immunology*; D005500:Follow-Up Studies; D006333:Heart Failure / Q000276:immunology* / Q000401:mortality / Q000523:psychology*; D006801:Humans; D007111:Immunity, Cellular; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D010359:Patient Readmission; D011569:Psychiatric Status Rating Scales; D018417:Th1 Cells; D018418:Th2 Cells
chemical_list: D016207:Cytokines