Parissis J T, Nikolaou M, Farmakis D, Bistola V, Paraskevaidis I A, Adamopoulos S, Filippatos G, Kremastinos D T
Heart Failure Clinic, Second Department of Cardiology, Attikon University Hospital, Athens, Greece.
Heart. 2008 May;94(5):585-9. doi: 10.1136/hrt.2007.117390. Epub 2007 Aug 29.
Depression is common among patients with chronic heart failure (CHF) and has been independently associated with a poorer prognosis.
This study evaluated the clinical and prognostic value of depression scales (Beck Depression Inventory (BDI), Zung Self-rating Depression Scale (Zung SDS)) along with plasma B-type natriuretic peptide (BNP) in CHF.
155 hospitalised CHF patients (ejection fraction 26.9% (SD 6.4%)) were studied by depression (BDI, Zung SDS) and functional questionnaires (Kansas City Cardiomyopathy Questionnaire (KCCQ), Duke Activity Status Index (DASI)), BNP and 6-minute walk test (6MWT). Patients were followed for 6 months for cardiovascular events, including death from any cause or rehospitalisation for CHF decompensation.
Seventy-six (49%) patients with depressive symptoms, as estimated by both scales, had significantly lower DASI and KCCQ scores (13.2 (SD 9.9) vs 23.6 (SD 13.0) and 26.6 (SD 15.0) vs 45.0 (SD 17.0), respectively; p<0.001), higher BNP (921 (SD 889) vs 439 (SD 267) pg/ml, p = 0.001) and reduced 6MWT (270 (SD 130) vs 337 (SD 133); p<0.001). According to logistic regression analysis, Zung SDS and BNP were independently associated with adverse clinical outcomes; values of Zung SDS >or=40 and of BNP >or=290 pg/ml predicted future events with a sensitivity of 82% and 94% and a specificity of 45% and 46%, respectively. The combination of Zung SDS plus BNP had an additive prognostic value, predicting events with a sensitivity of 77% and a specificity of 70% (event-free survival: Zung <40 and BNP <290 pg/ml; 170 (SD 9) days; Zung >or=40 and BNP <290 pg/ml, 159 (SD 14) days; Zung <40 and BNP >or=290 pg/ml, 118 (SD 15) days; Zung >or=40 and BNP >or=290 pg/ml, 73 (SD 8) days, p<0.001).
CHF patients with depressive symptoms have impaired physical activity, associated with excessive neurohormonal activation. Among the studied scales, Zung SDS seemed to independently predict clinical outcome, especially in patients with increased plasma BNP concentration. Hence, the combination of those two modalities provides a practical means for risk stratification in CHF.
抑郁症在慢性心力衰竭（CHF）患者中很常见，并且与较差的预后独立相关。
本研究评估了抑郁量表（贝克抑郁量表（BDI）、zung自评抑郁量表（zung SDS））以及血浆B型利钠肽（BNP）在CHF中的临床和预后价值。
通过抑郁量表（BDI、zung SDS）和功能问卷（堪萨斯城心肌病问卷（KCCQ）、杜克活动状态指数（DASI））、BNP和6分钟步行试验（6MWT）对155例住院CHF患者（射血分数26.9%（标准差6.4%））进行研究。对患者随访6个月，观察心血管事件，包括任何原因导致的死亡或因CHF失代偿再次住院。
根据两种量表评估，76例（49%）有抑郁症状的患者DASI和KCCQ评分显著更低（分别为13.2（标准差9.9）对23.6（标准差13.0）以及26.6（标准差15.0）对45.0（标准差17.0）；p<0.001），BNP更高（921（标准差889）对439（标准差267）pg/ml，p = 0.001），6MWT降低（270（标准差130）对337（标准差133）；p<0.001）。根据逻辑回归分析，zung SDS和BNP与不良临床结局独立相关；zung SDS≥40以及BNP≥290 pg/ml预测未来事件的敏感度分别为82%和94%，特异度分别为45%和46%。zung SDS加BNP联合使用具有相加的预后价值，预测事件的敏感度为77%，特异度为70%（无事件生存期：zung<40且BNP<290 pg/ml；170（标准差9）天；zung≥40且BNP<290 pg/ml，159（标准差14）天；zung<40且BNP≥290 pg/ml，118（标准差15）天；zung≥40且BNP≥290 pg/ml，73（标准差8）天，p<0.001）。
有抑郁症状的CHF患者身体活动受损，与神经激素过度激活有关。在所研究的量表中，zung SDS似乎能独立预测临床结局，尤其是在血浆BNP浓度升高的患者中。因此，这两种方法联合使用为CHF风险分层提供了一种实用手段。
