Second Department of Cardiology, Heart Failure Clinic, Attikon University Hospital, 15122 Maroussi, Athens, Greece.
Eur J Heart Fail. 2009 Oct;11(10):967-72. doi: 10.1093/eurjhf/hfp125.
To assess the prognostic value of a wide spectrum of neurohormonal and inflammatory markers along with functional status and exercise capacity, in hospitalized chronic heart failure (CHF) patients with depressive symptoms.
A total of 300 consecutive hospitalized CHF patients were screened for depressive symptomatology using the Zung self-rated depression scale (SDS). Patients with depressive symptoms (Zung SDS > or = 40) underwent a 6 min walking test, and evaluation of left ventricular ejection fraction, B-type natriuretic peptide (BNP), and plasma inflammatory/anti-inflammatory factors [interleukin (IL)-6, IL-10, tumour necrosis factor-alpha, soluble intercellular adhesion molecule-1, and vascular cell adhesion molecule-1]. Patients were subsequently followed for up to 1 year for major adverse cardiovascular events (MACE, death or hospitalization due to cardiovascular causes). One hundred and fourteen patients (38%) had a Zung SDS > or = 40. One-year event-free survival of these patients was 19% (mean +/- SE, 150 +/- 12 days). In multivariate analysis, only BNP (HR = 1.001, P = 0.002) and IL-10 (HR = 0.864, P = 0.049) were independent predictors of MACE. Using receiver operator characteristics analysis-derived cut-offs, a BNP value of 290 pg/mL predicted MACE with 86% sensitivity and 69% specificity, whereas an IL-10 value of 5 pg/mL predicted MACE with 61% sensitivity and 78% specificity. Event-free survival differed significantly between patients with BNP < 290 pg/mL and IL-10 > 5 pg/mL (261 +/- 44 days) and those with BNP > 290 pg/mL and IL-10 < 5 pg/mL (79 +/- 11 days, P = 0.0001).
Neurohormonal activation and defective anti-inflammatory properties are independent predictors of long-term outcome in hospitalized CHF patients with depressive symptoms.
评估广谱神经激素和炎症标志物以及功能状态和运动能力在伴有抑郁症状的住院慢性心力衰竭（CHF）患者中的预后价值。
对 300 例连续住院的 CHF 患者使用zung 自评抑郁量表（SDS）筛查抑郁症状。有抑郁症状的患者（zung SDS≥40）进行 6 分钟步行试验，并评估左心室射血分数、B 型利钠肽（BNP）和血浆炎症/抗炎因子[白细胞介素（IL）-6、IL-10、肿瘤坏死因子-α、可溶性细胞间黏附分子-1 和血管细胞黏附分子-1]。随后对这些患者进行了长达 1 年的随访，以观察主要不良心血管事件（MACE，死亡或心血管原因住院）的发生情况。有 114 例患者（38%）zung SDS≥40。这些患者的 1 年无事件生存率为 19%（平均值±SE，150±12 天）。多变量分析显示，只有 BNP（HR=1.001，P=0.002）和 IL-10（HR=0.864，P=0.049）是 MACE 的独立预测因素。通过接受者操作特征曲线分析得出的截断值，BNP 值为 290 pg/ml 时，预测 MACE 的敏感性为 86%，特异性为 69%；而 IL-10 值为 5 pg/ml 时，预测 MACE 的敏感性为 61%，特异性为 78%。BNP<290 pg/ml 和 IL-10>5 pg/ml 的患者无事件生存率明显高于 BNP>290 pg/ml 和 IL-10<5 pg/ml 的患者（261±44 天与 79±11 天，P=0.0001）。
神经激素激活和抗炎功能缺陷是伴有抑郁症状的住院 CHF 患者长期预后的独立预测因素。
