Suzuki Tsuyoshi, Shiga Tsuyoshi, Kuwahara Kazue, Kobayashi Sayaka, Suzuki Shinichi, Nishimura Katsuji, Suzuki Atsushi, Ejima Koichiro, Manaka Tetsuyuki, Shoda Morio, Ishigooka Jun, Kasanuki Hiroshi, Hagiwara Nobuhisa
Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
Pacing Clin Electrophysiol. 2010 Dec;33(12):1455-61. doi: 10.1111/j.1540-8159.2010.02887.x. Epub 2010 Oct 14.
It is unclear whether depression persists in patients with implantable cardioverter defibrillators (ICDs). We evaluated the prevalence and persistence of depression in ICD patients over a 2-year period.
The study included 90 consecutively hospitalized patients. Patients underlying heart disease was 24% coronary artery disease, 29% idiopathic dilated cardiomyopathy, 24% hypertrophic cardiomyopathy, 13% idiopathic VF/long QT syndrome and miscellaneous conditions 11%. A secondary indication for ICD implantation was present in 20 patients. All patients completed the Zung Self-Rating Depression Scale (SDS) at study baseline and at the their routine follow-up visit 2 years after the baseline questionnaire. Delivery of ICD therapies was tracked throughout the 2 years.
Depression, indicated by a Zung SDS index score exceeding 60, was present in 29 (32%) of patients at study baseline. Depression was present in 11/51 (21%) patients scheduled to undergo ICD implantation, 2/2 (100%) patients whose device was upgraded to a CRT-D, 3/14 (21%) patients who had undergone pulse generator replacement, 7/14 (50%) patients who experienced electrical storm and 6/9 (66%) patients hospitalized with acute decompensated heart failure. NYHA functional class III was significantly associated with depression at baseline (HR 6.7, 95% CI 1.68-27.2, p = 0.0007). No differences were noted for female gender, demographics, β-blocker use, or LVEF ≤35% (p = ns). Depression was present in 25 (28%) of patients at 2 years follow-up, persisting in 21 (72%) of patients whose Zung SDS scores were elevated at baseline. The median time from ICD shock therapy to completion of the 2 year questionnaire was 9 months (range, 1-22). Patients who were depressed (9/25, 36%) experienced more shocks than non-depressed patients (6/65, 9%) after 2 years (p = 0.002).
Depression is not uncommon among patients who meet criteria for ICD implantation and persists over time particularly when functional status is impaired. Depression is associated with a higher incidence shock therapy.
植入式心脏复律除颤器（ICD）患者的抑郁症状是否持续存在尚不清楚。我们评估了ICD患者在两年期间抑郁的患病率和持续性。
该研究纳入了90例连续住院患者。患者潜在的心脏病包括24%为冠状动脉疾病，29%为特发性扩张型心肌病，24%为肥厚型心肌病，13%为特发性室颤/长QT综合征，其他情况占11%。20例患者存在植入ICD的次要指征。所有患者在研究基线以及基线问卷2年后的常规随访时均完成了zung自评抑郁量表（SDS）。在整个两年期间追踪ICD治疗的实施情况。
在研究基线时，zung SDS指数评分超过60表明存在抑郁的患者有29例（32%）。计划植入ICD的患者中有11/51例（21%）存在抑郁，设备升级为CRT-D的患者中有2/2例（100%）存在抑郁，进行了脉冲发生器更换的患者中有3/14例（21%）存在抑郁，经历电风暴的患者中有7/14例（50%）存在抑郁，因急性失代偿性心力衰竭住院的患者中有6/9例（66%）存在抑郁。NYHA心功能III级与基线时的抑郁显著相关（HR 6.7，95%CI 1.68-27.2，p = 0.0007）。在女性性别、人口统计学、使用β受体阻滞剂或左室射血分数≤35%方面未发现差异（p = 无统计学意义）。在两年随访时，25例（28%）患者存在抑郁，基线时zung SDS评分升高的患者中有21例（72%）抑郁持续存在。从ICD电击治疗到完成两年问卷的中位时间为9个月（范围1-22个月）。两年后，抑郁患者（9/25，36%）比非抑郁患者（6/65，9%）经历了更多的电击（p = 0.002）。
在符合ICD植入标准的患者中，抑郁并不少见，且会随着时间持续存在，尤其是在功能状态受损时。抑郁与更高的电击治疗发生率相关。
