Mood disorders and outcome in patients receiving cardiac resynchronization therapy.
BACKGROUND
Mood disorders (MD) have been demonstrated to influence outcome in cardiac disease in general and specifically in chronic heart failure (HF). Little is known about their possible effect on response to cardiac resynchronization therapy (CRT).


OBJECTIVE
To evaluate the influence of MD on CRT response.


METHODS
We conducted a retrospective chart review of all cardiac CRT-D (CRT defibrillator) recipients (N = 153) at the Veterans Affairs Pittsburgh Healthcare System from beginning of 2004 through end of 2006. All-cause death and HF-related hospitalizations (HFH), individually and combined, were sought through 2009.


RESULTS
During a mean follow-up time of 31.4 ± 14.7 months, there were 48 (31.4%) deaths and 55 (35.9%) HFHs in HF patients having New York Heart Association class of 2.9 ± 0.3, left ventricular ejection fraction (LVEF) of 25.8 ± 9.1%, left ventricular end-diastolic diameter (LVEDD) of 61.6 ± 11.6 mm, and QRS of 152 ± 30.5 ms . A total of 65 (42.5%) patients had MD (depression, anxiety, or posttraumatic stress disorder). Compared to others, patients in the MD group were at a significantly higher risk of HFH alone (47.7% vs 27.3%, P = 0.009) or when combined with death (58.5% vs 39.8%, P = 0.022) but not death alone (35.4% vs 28.4%, P = 0.36). The significant predictive effect of MD on HFH alone and when combined with death shown in univariate analysis was not attenuated after adjustment for age, ejection fraction, etiology of cardiomyopathy, cumulative number of any shocks, smoking, and evidence of postimplantation echocardiographic improvement.


CONCLUSIONS
MD in patients with advanced but stable HF receiving CRT-D therapy was a predictor of HFH alone or when combined with death but not mortality alone.
The Cardiovascular Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA. Alaa.Shalaby@va.gov
Alaa
A
Shalaby
Genevieve
G
Brumberg
Aiman
A
El-Saed
Samir
S
Saba
D000368:Aged; D000369:Aged, 80 and over; D058406:Cardiac Resynchronization Therapy / Q000523:psychology / Q000706:statistics & numerical data*; D002423:Cause of Death; D017147:Defibrillators, Implantable / Q000523:psychology / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000453:epidemiology* / Q000503:physiopathology / Q000523:psychology; D015995:Prevalence; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D016896:Treatment Outcome