Aydin Sunbul Esra, Sunbul Murat, Gulec Huseyin
Erenkoy Training and Research Hospital for Psychiatric and Neurological Disorders, Psychiatry Clinic, Istanbul, Turkey.
Marmara University Faculty of Medicine, Department of Cardiology, Istanbul, Turkey.
Gen Hosp Psychiatry. 2017 Jan-Feb;44:4-9. doi: 10.1016/j.genhosppsych.2016.10.006. Epub 2016 Oct 27.
Depression is an independent risk factor in cardiovascular diseases. Changes in the cardiac autonomic functions and pro-inflammatory processes are potential biological factors. Endothelial dysfunction plays an important role in the etiopathogenesis of atherosclerosis. Our objective was to evaluate the impact of major depression on heart rate variability and endothelial dysfunction in patients with stable CAD.
The study group included 65 CAD patients with a diagnosis of major depression and 54 CAD patients without major depression. All study population underwent transthoracic echocardiography, measurement of flow mediated dilatation (FMD) and 24-h holter recording for heart rate variability (HRV). Blood samples were drawn to determine the inflammatory parameters. Severity of depressive episode was assessed by Montgomery-Asberg Depression Scale (MADRS).
The distribution of age and sex was similar in the patient and control groups (P=0.715, 0.354, respectively). There was no significant difference in medications used between the groups. Echocardiographic parameters were similar between the groups. Inflammatory parameters were also similar between the groups. HRV parameters were significantly lower in the patient group than controls. The absolute FMD value and percentage FMD were significantly lower in the patient group than controls (P<0.001). The MADRS score correlated with pNN50 in both groups (P<0.05), and with FMD in the control group (P<0.001), even after adjusting for age and gender (P<0.001).
MADRS score was an independent predictor of pNN50 level, percentage and absolute FMD values regardless of age and gender. Clinician should pay more attention for evaluation of depressive patients with CAD.
抑郁症是心血管疾病的独立危险因素。心脏自主神经功能和促炎过程的改变是潜在的生物学因素。内皮功能障碍在动脉粥样硬化的发病机制中起重要作用。我们的目的是评估重度抑郁症对稳定型冠心病患者心率变异性和内皮功能障碍的影响。
研究组包括65例诊断为重度抑郁症的冠心病患者和54例无重度抑郁症的冠心病患者。所有研究对象均接受经胸超声心动图检查、血流介导的血管舒张功能（FMD）测量以及24小时动态心电图记录以评估心率变异性（HRV）。采集血样以测定炎症参数。采用蒙哥马利-阿斯伯格抑郁量表（MADRS）评估抑郁发作的严重程度。
患者组和对照组的年龄及性别分布相似（P分别为0.715和0.354）。两组间所用药物无显著差异。两组间超声心动图参数相似。两组间炎症参数也相似。患者组的HRV参数显著低于对照组。患者组的绝对FMD值和FMD百分比显著低于对照组（P<0.001）。即使在调整年龄和性别后，MADRS评分在两组中均与pNN50相关（P<0.05），在对照组中与FMD相关（P<0.001）（P<0.001）。
无论年龄和性别，MADRS评分都是pNN50水平、FMD百分比和绝对FMD值的独立预测因子。临床医生应更加关注对冠心病抑郁患者的评估。
