Autonomic cardiovascular dysregulation as a potential mechanism underlying depression and coronary artery bypass grafting surgery outcomes.
BACKGROUND
Coronary artery bypass grafting (CABG) is often used to treat patients with significant coronary heart disease (CHD). To date, multiple longitudinal and cross-sectional studies have examined the association between depression and CABG outcomes. Although this relationship is well established, the mechanism underlying this relationship remains unclear. The purpose of this study was twofold. First, we compared three markers of autonomic nervous system (ANS) function in four groups of patients: 1) Patients with coronary heart disease and depression (CHD/Dep), 2) Patients without CHD but with depression (NonCHD/Dep), 3) Patients with CHD but without depression (CHD/NonDep), and 4) Patients without CHD and depression (NonCHD/NonDep). Second, we investigated the impact of depression and autonomic nervous system activity on CABG outcomes.


METHODS
Patients were screened to determine whether they met some of the study's inclusion or exclusion criteria. ANS function (i.e., heart rate, heart rate variability, and plasma norepinephrine levels) were measured. Chi-square and one-way analysis of variance were performed to evaluate group differences across demographic, medical variables, and indicators of ANS function. Logistic regression and multiple regression analyses were used to assess impact of depression and autonomic nervous system activity on CABG outcomes.


RESULTS
The results of the study provide some support to suggest that depressed patients with CHD have greater ANS dysregulation compared to those with only CHD or depression. Furthermore, independent predictors of in-hospital length of stay and non-routine discharge included having a diagnosis of depression and CHD, elevated heart rate, and low heart rate variability.


CONCLUSIONS
The current study presents evidence to support the hypothesis that ANS dysregulation might be one of the underlying mechanisms that links depression to cardiovascular CABG surgery outcomes. Thus, future studies should focus on developing and testing interventions that targets modifying ANS dysregulation, which may lead to improved patient outcomes.
Dao
Tam K
TK
University of Houston, 4800 Calhoun Rd,, Houston, TX 77004, USA. tkdao@uh.edu
Youssef
Nagy A
NA
Gopaldas
Raja R
RR
Chu
Danny
D
Bakaeen
Faisal
F
Wear
Emily
E
Menefee
Deleene
D
D001341:Autonomic Nervous System / Q000503:physiopathology*; D001026:Coronary Artery Bypass / Q000523:psychology; D003327:Coronary Disease / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D003866:Depressive Disorder / Q000150:complications / Q000503:physiopathology*; D006339:Heart Rate; D006801:Humans; D007902:Length of Stay; D009638:Norepinephrine / Q000097:blood; D016896:Treatment Outcome
D009638:Norepinephrine
Circulation. 1996 Mar 1;93(5):1043-65
8598068
Psychosom Med. 2005 May-Jun;67 Suppl 1:S29-33
15953797
Aten Primaria. 2002 Apr 15;29(6):329-36; discussion 336-7
11996711
Arch Intern Med. 2000 May 8;160(9):1354-60
10809041
Am J Psychiatry. 1983 Dec;140(12):1623-5
6650697
Am J Psychiatry. 1982 Oct;139(10):1315-8
6289682
J Clin Endocrinol Metab. 1999 Jul;84(7):2523-31
10404831
Public Health Nutr. 2006 Sep;9(6):755-62
16925881
Circulation. 1995 Feb 15;91(4):999-1005
7531624
J Psychosom Res. 2006 Dec;61(6):775-81
17141665
Addiction. 1993 Jun;88(6):791-804
8329970
Psychosom Med. 1997 May-Jun;59(3):231-5
9178333
J Crit Care. 2005 Mar;20(1):12-9
16015512
Appl Psychophysiol Biofeedback. 2000 Sep;25(3):177-91
10999236
BMC Psychiatry. 2007 Sep 12;7:47
17850655
J Clin Invest. 1987 Nov;80(5):1332-41
3316275
J Clin Epidemiol. 1992 Jun;45(6):613-9
1607900
J Neurol Neurosurg Psychiatry. 1995 Sep;59(3):299-302
7673960
Arch Gen Psychiatry. 1982 Mar;39(3):295-300
7065840
Lancet. 2003 Aug 23;362(9384):604-9
12944059
Med Sci Sports Exerc. 2003 Aug;35(8):1381-95
12900694
N Engl J Med. 1980 Aug 21;303(8):436-44
6248784
J Chronic Dis. 1987;40(5):373-83
3558716
Arch Gen Psychiatry. 1994 May;51(5):411-22
8179465
Psychosomatics. 2004 Mar-Apr;45(2):129-34
15016926
Arch Intern Med. 2000 Jul 10;160(13):1977-89
10888972
J Affect Disord. 1994 Dec;32(4):271-5
7897091
J Psychosom Res. 2008 Mar;64(3):285-90
18291243
J Clin Psychiatry. 1990 Jul;51 Suppl:4-9; discussion 10-1
2195012
Circulation. 2005 Jan 25;111(3):250-3
15668351
Child Dev. 2000 Mar-Apr;71(2):273-87
10834463
Eur J Cardiovasc Prev Rehabil. 2008 Aug;15(4):386-96
18677161
Psychosom Med. 1988 Nov-Dec;50(6):627-33
2976950
Am J Psychiatry. 1985 Sep;142(9):1017-31
2862799
Lancet. 2001 Nov 24;358(9295):1766-71
11734233
J Lab Clin Med. 1985 Dec;106(6):624-9
4067376
J Psychosom Res. 1988;32(2):159-64
3404497
J Psychosom Res. 2000 Apr-May;48(4-5):493-500
10880671
Psychosom Med. 2000 Sep-Oct;62(5):639-47
11020093
Psychosom Med. 2004 Sep-Oct;66(5):645-50
15385686