Carney R M, Blumenthal J A, Stein P K, Watkins L, Catellier D, Berkman L F, Czajkowski S M, O'Connor C, Stone P H, Freedland K E
Departments of Psychiatry, Washington University School of Medicine, St Louis, MO, USA.
Circulation. 2001 Oct 23;104(17):2024-8. doi: 10.1161/hc4201.097834.
Clinical depression is associated with an increased risk for mortality in patients with a recent myocardial infarction (MI). Reduced heart rate variability (HRV) has been suggested as a possible explanation for this association. The purpose of this study was to determine if depression is associated with reduced HRV in patients with a recent MI.
Three hundred eighty acute MI patients with depression and 424 acute MI patients without depression were recruited. All underwent 24-hour ambulatory electrocardiographic monitoring after hospital discharge. In univariate analyses, 4 indices of HRV were significantly lower in patients with depression than in patients without depression. Variables associated with HRV were then compared between patients with and without depression, and potential confounds were identified. These variables (age, sex, diabetes, and present cigarette smoking) were entered into an analysis of covariance model, followed by depression status. In the final model, all but one HRV index (high-frequency power) remained significantly lower in patients with depression than in patients without depression.
We conclude that greater autonomic dysfunction, as reflected by decreased HRV, is a plausible mechanism linking depression to increased cardiac mortality in post-MI patients.
临床抑郁症与近期心肌梗死（MI）患者的死亡风险增加有关。心率变异性（HRV）降低被认为是这种关联的一种可能解释。本研究的目的是确定抑郁症是否与近期心肌梗死患者的HRV降低有关。
招募了380例患有抑郁症的急性心肌梗死患者和424例无抑郁症的急性心肌梗死患者。所有患者出院后均接受24小时动态心电图监测。在单因素分析中，抑郁症患者的4项HRV指标显著低于无抑郁症患者。然后比较了有抑郁症和无抑郁症患者之间与HRV相关的变量，并确定了潜在的混杂因素。将这些变量（年龄、性别、糖尿病和当前吸烟情况）纳入协方差分析模型，随后纳入抑郁状态。在最终模型中，除一项HRV指标（高频功率）外，抑郁症患者的所有其他HRV指标仍显著低于无抑郁症患者。
我们得出结论，HRV降低所反映的更严重自主神经功能障碍是将抑郁症与心肌梗死后患者心脏死亡率增加联系起来的一个合理机制。
