title: Determinants of Dyspnea in Chronic Heart Failure.
abstract: BACKGROUND
  Dyspnea is a hallmark symptom of heart failure (HF), associated with impaired functional capacity and quality of life. The experience of dyspnea is multifactorial and may originate from different sources. This study set out to examine the relative importance of potential contributors to dyspnea, ie, disease severity, inflammation and psychologic distress in a large prospective cohort of chronic HF patients. This study further aimed to examine the differential influence of cognitive and somatic symptoms of psychologic distress.
  
  
  RESULTS
  Dyspnea complaints (Health Complaints Scale), demographic and clinical variables, and psychologic factors (ie, depression, anxiety, and Type D personality) were assessed in 464 HF patients (mean age 66.0 y, 70% men) at baseline and 1-year follow-up. Inflammatory markers (ie, tumor necrosis factor [TNF] α, interleukin [IL] 6, IL-10, soluble TNF receptors 1 and 2) were also assessed at both time points in a subsample (n = 247). Linear mixed modeling analysis with maximum likelihood estimation showed that when determinant clusters were entered separately, comorbid chronic obstructive pulmonary disease (COPD) was significantly associated with dyspnea complaints (P = .039), as were depression (P < .001) and anxiety (P < .001), whereas inflammation did not significantly affect dyspnea complaints. When all determinant clusters and covariates were entered together, results showed that body mass index (P = .013), COPD (P = .034), age (P = .005), depression (P < .001), and anxiety (P < .001) were significant independent associates of dyspnea complaints. Somatic depressive and somatic anxiety symptoms were responsible for these latter associations.
  
  
  CONCLUSIONS
  The experience and report of dyspnea in HF is determined foremost by somatic symptoms of psychologic distress, being of older age, being overweight, and having comorbid COPD, with disease severity and systemic inflammation levels playing an ancillary role. These findings suggest that psychologic distress should be considered when treating dyspnea complaints in patients with HF.
authors.affiliation: Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands. Electronic address: h.m.kupper@tilburguniversity.edu.
authors.forename: Nina
authors.initials: N
authors.lastname: Kupper
authors.affiliation: Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Bonhof
authors.affiliation: Clinical Chemical Hematology Lab, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.
authors.forename: Bert
authors.initials: B
authors.lastname: Westerhuis
authors.affiliation: Department of Cardiology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.
authors.forename: Jos
authors.initials: J
authors.lastname: Widdershoven
authors.affiliation: Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.
authors.forename: Johan
authors.initials: J
authors.lastname: Denollet
mesh_terms: D000368:Aged; D001007:Anxiety / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D002908:Chronic Disease; D003863:Depression / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D004417:Dyspnea / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000097:blood* / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D029424:Pulmonary Disease, Chronic Obstructive / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology
chemical_list: D015415:Biomarkers
keywords: Dyspnea; Type D; anxiety; depression; heart failure; inflammation