Lundgren Scott, Poon Cecilia Y M, Selim Ahmed, Lowes Brian D, Zolty Ronald, Burdorf Adam, Potashnik-Peled Yael, Moulton Michael J, Um John Y, Raichlin Eugenia
Division of Cardiology, University of Nebraska Medical Center, Omaha, NE - USA.
Psychology Department, Nebraska Medicine, Omaha, NE - USA.
Int J Artif Organs. 2017 Nov 1:0. doi: 10.5301/ijao.5000650.
Depression and anxiety are associated with a worse prognosis in heart failure patients. The aim of this study was to identify the prevalence of depression and anxiety in left ventricular assist device (LVAD) candidates and assess their effect on post-LVAD outcomes.
Based on the pre-LVAD psychological assessment, the total cohort of 246 patients were divided into 4 groups: 1) no depression or anxiety (NDep&Anx group, n = 138); 2) isolated depression (Dep group, n = 42); 3) isolated anxiety (Anx group, n = 32), and 4) combined depression and anxiety (Dep&Anx group, n = 34).
The Dep&Anx group was associated with higher prevalence of female gender (p = 0.03), higher body mass index (p = 0.03), elevated E/E' (p = 0.003), and increased Model For End-Stage Liver Disease (MELD) XI score (p = 0.04) prior to LVAD as compared to the other 3 subgroups. The prevalence of other major psychiatric disorders (p = 0.03) and narcotic dependence (p = 0.004) was higher in the Dep&Anx group. Post-LVAD implantation, heart rate and filling pressures were elevated and readmission rate was higher (p = 0.001) in the Dep&Anx group. There was no difference in survival between the groups (p = 0.40, Log-Rank test).
Pre-existing anxiety and depression was associated with worse HF pre- and post-LVAD implantation and higher readmissions rate after LVAD implantation.
抑郁症和焦虑症与心力衰竭患者较差的预后相关。本研究的目的是确定左心室辅助装置（LVAD）候选患者中抑郁症和焦虑症的患病率，并评估它们对LVAD植入后结局的影响。
根据LVAD植入前的心理评估，将246例患者的总队列分为4组：1）无抑郁或焦虑（无抑郁和焦虑组，n = 138）；2）单纯抑郁症（抑郁组，n = 42）；3）单纯焦虑症（焦虑组，n = 32），以及4）合并抑郁症和焦虑症（抑郁和焦虑组，n = 34）。
与其他3个亚组相比，抑郁和焦虑组在LVAD植入前女性患病率更高（p = 0.03）、体重指数更高（p = 0.03）、E/E'升高（p = 0.003）以及终末期肝病模型（MELD）XI评分增加（p = 0.04）。抑郁和焦虑组中其他主要精神障碍的患病率（p = 0.03）和麻醉药物依赖的患病率（p = 0.004）更高。LVAD植入后，抑郁和焦虑组的心率和充盈压升高，再入院率更高（p = 0.001）。各组之间的生存率无差异（p = 0.40，对数秩检验）。
术前存在的焦虑和抑郁与LVAD植入前后较差的心力衰竭情况以及LVAD植入后较高的再入院率相关。
