Kourkoveli Panagiota, Rammos Spyros, Parissis John, Maillis Antonis, Kremastinos Dimitrios, Paraskevaidis Ioannis
Department of Pediatric Cardiology and Adult Congenital Heart Disease, Onassis Cardiac Surgery Center, Athens, Greece.
Department of Cardiology, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Congenit Heart Dis. 2015 May-Jun;10(3):240-7. doi: 10.1111/chd.12200. Epub 2014 Jun 28.
To determine the presence of depressive symptoms in adolescent and adult patients with CHD and their impact on prognosis, using self-rating depression scales.
Prospective study.
Outpatient clinic of a tertiary center.
Sixty ambulatory adolescent and adult patients admitted at the outpatient clinic for regular evaluation.
Self-rating depression questionnaires (Beck Depression Inventory [BDI] and Zung Self-Rating Depression Scale [Zung SDS]) were administered on admission. Patients were characterized as having depressive symptoms when scores on both questionnaires were above cutoff levels and were subsequently followed for 5.1 ± 1.1 years for major adverse cardiovascular events (MACEs; death or hospitalization for cardiac reasons).
Seventeen patients (mean age 28.9 ± 11.4 years) were characterized as having depressive symptoms. According to univariate Cox regression analysis, the presence of depressive symptoms was independently associated with adverse clinical outcome. During the follow-up period, patients with depressive symptoms had a shorter event-free survival (1559 ± 92 days vs. 1077 ± 188 days, P = .00215) and a twofold higher risk of getting a MACE, compared with patients without (95% CI 1.630 to 3.616, P < .05). Based on receiver operator characteristics, the BDI had a better prognostic value for future MACEs (area under curve = 0.662, 95% CI 0.5442 to 0.7792; P < .05) compared with the Zung SDS. Mean event-free survival for patients with BDI ≥ 10 was 986 ± 179 days vs. 1624 ± 83 days for patients with BDI < 10.
The incidence of depressive symptomatology in patients with CHD is rather high and is associated with poorer prognosis. The BDI seems to independently predict adverse clinical outcome. Standardized screening tools and psychosocial interventions to improve the well being of these patients should be a priority in the overall care of this population.
使用自评抑郁量表确定冠心病青少年和成年患者中抑郁症状的存在情况及其对预后的影响。
前瞻性研究。
三级中心门诊。
60名在门诊接受定期评估的非卧床青少年和成年患者。
入院时使用自评抑郁问卷（贝克抑郁量表[BDI]和zung自评抑郁量表[zung SDS]）。当两个问卷的得分均高于临界值时，患者被判定为有抑郁症状，随后对其进行5.1±1.1年的随访，观察主要不良心血管事件（MACE；因心脏原因死亡或住院）。
17名患者（平均年龄28.9±11.4岁）被判定为有抑郁症状。根据单因素Cox回归分析，抑郁症状的存在与不良临床结局独立相关。在随访期间，有抑郁症状的患者无事件生存期较短（1559±92天对1077±188天，P = 0.00215），与无抑郁症状的患者相比，发生MACE的风险高出两倍（95%CI 1.630至3.616，P < 0.05）。根据受试者工作特征曲线，与zung SDS相比，BDI对未来MACE的预后价值更好（曲线下面积 = 0.662，95%CI 0.5442至0.7792；P < 0.05）。BDI≥10的患者平均无事件生存期为986±179天，而BDI < 10的患者为1624±83天。
冠心病患者中抑郁症状的发生率相当高，且与较差的预后相关。BDI似乎能独立预测不良临床结局。在对这一人群的整体护理中，应优先使用标准化筛查工具和心理社会干预措施来改善这些患者的健康状况。
