Relationship between depression, BNP levels and ventricular impairment in heart failure.
BACKGROUND
Depression is a common comorbidity in heart failure (HF); however, the mechanisms related to a poorer outcome of depressed patients with HF remain unclear.


OBJECTIVE
To evaluate the role of severe depression in the outcome of patients with decompensated HF.


METHODS
A total of 43 patients with advanced HF, EF < 40.0%, and hospitalized for cardiac compensation were consecutively studied. After history taking and physical examination, the patients underwent laboratory tests including BNP determination. After the diagnosis of depression was made, the Hamilton-D scale was applied. Severe depression was defined by a score equal to or greater than 18. The clinical and laboratory variables according to the presence or absence of severe depression were analyzed using logistic regression. The ROC curve defined the cut-off point for BNP.


RESULTS
Severe or very severe depression was identified in 24 (55.8%) patients. Severely depressed patients did not differ from non-depressed patients as regards age, gender and renal function, but showed less cardiac impairment (EF 23.4 ± 7.2% vs 19.5 ± 5.2%; p = 0.046) and higher BNP levels (2,582.8 ± 1,596.6 pg/ml vs 1,206.6 ± 587.0 pg/ml; p < 0.001). However, patients with BNP levels higher than 1,100 pg/ml had a 12.0-fold higher chance (odds ratio [95% CI] = 2.61 - 55.26) of developing severe depression.


CONCLUSIONS
Patients with severe depression showed a higher degree of neurohormonal stimulation despite their lower degree of ventricular dysfunction. The pathophysiological changes related to depression, leading to increased neurohormonal stimulation and cytokines, probably contributed to this more intense clinical manifestation even in the presence of less cardiac damage.
Aguiar
Vera Barretto
VB
Hospital Auxiliar de Cotoxó - Instituto do Coração - HC FMUSP, São Paulo, SP - Brazil.
Ochiai
Marcelo Eidi
ME
Cardoso
Juliano Novais
JN
Del Carlo
Carlos H
CH
Morgado
Paulo Cesar
PC
Munhoz
Robinson Tadeu
RT
Pereira-Barretto
Antonio Carlos
AC
D015415:Biomarkers / Q000097:blood; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology*; D004812:Epidemiologic Methods; D005260:Female; D006333:Heart Failure / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D012016:Reference Values; D018754:Ventricular Dysfunction / Q000453:epidemiology*
D015415:Biomarkers; D020097:Natriuretic Peptide, Brain