title: Depression and anxiety as predictors of heart rate variability after myocardial infarction.
abstract: BACKGROUND
  Reduced heart rate variability (HRV) is a prognostic factor for cardiac mortality. Both depression and anxiety have been associated with increased risk for mortality in cardiac patients. Low HRV may act as an intermediary in this association. The present study examined to what extent depression and anxiety differently predict 24-h HRV indices recorded post-myocardial infarction (MI).
  
  
  METHODS
  Ninety-three patients were recruited during hospitalization for MI and assessed on self-reported symptoms of depression and anxiety. Two months post-MI, patients were assessed on clinical diagnoses of lifetime depressive and anxiety disorder. Adequate 24-h ambulatory electrocardiography data were obtained from 82 patients on average 78 days post-MI.
  
  
  RESULTS
  In unadjusted analyses, lifetime diagnoses of major depressive disorder was predictive of lower SDNN [standard deviation of all normal-to-normal (NN) intervals; beta=-0.26, p=0.022] and SDANN (standard deviation of all 5-min mean NN intervals; beta=0.25, p=0.023), and lifetime anxiety disorder of lower RMSSD (root mean square of successive differences; beta=-0.23, p=0.039). Depression and anxiety symptoms did not significantly predict HRV. After adjustment for age, sex, cardiac history and multi-vessel disease, lifetime depressive disorder was no longer predictive of HRV. Lifetime anxiety disorder predicted reduced high-frequency spectral power (beta=-0.22, p=0.039) and RMSSD (beta=-0.25, p=0.019), even after additional adjustment of anxiety symptoms.
  
  
  CONCLUSIONS
  Clinical anxiety, but not depression, negatively influenced parasympathetic modulation of heart rate in post-MI patients. These findings elucidate the physiological mechanisms underlying anxiety as a risk factor for adverse outcomes, but also raise questions about the potential role of HRV as an intermediary between depression and post-MI prognosis.
authors.affiliation: CoRPS-Centre of Research on Psychology in Somatic Diseases, Tilburg University, and Department of Cardiology, St Elisabeth Hospital Tilburg, Tilburg, The Netherlands. E.J.Martens@uvt.nl
authors.forename: E J
authors.initials: EJ
authors.lastname: Martens
authors.forename: I
authors.initials: I
authors.lastname: Nyklícek
authors.forename: B M
authors.initials: BM
authors.lastname: Szabó
authors.forename: N
authors.initials: N
authors.lastname: Kupper
mesh_terms: D001007:Anxiety / Q000175:diagnosis / Q000453:epidemiology; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology*; D015897:Comorbidity; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology; D003865:Major Depressive Disorder / Q000175:diagnosis / Q000453:epidemiology*; D015716:Electrocardiography, Ambulatory / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000294:innervation; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D007206:Individuality; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology / Q000401:mortality; D009426:Netherlands / Q000453:epidemiology; D010275:Parasympathetic Nervous System / Q000502:physiology; D011379:Prognosis; D012307:Risk Factors