Bäz Laura, Puscholt Marisa, Lasch Claudia, Diab Mahmoud, Möbius-Winkler Sven, Schulze P Christian, Dannberg Gudrun, Franz Marcus
Department of Internal Medicine I, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany.
Department of Cardiothoracic Surgery, Jena University Hospital, Friedrich Schiller University, 07747 Jena, Germany.
J Clin Med. 2021 Apr 8;10(8):1579. doi: 10.3390/jcm10081579.
Depression and anxiety are frequently occurring and likely to be linked to the severity of cardiac diseases like aortic stenosis (AS). This seems to be of interest since a staging classification of extra-valvular cardiac damage in AS has been introduced and shown to be of prognostic relevance.
The current study aimed to investigate the frequency of depression and anxiety in association to staging and their dynamics after transcatheter aortic valve implantation (TAVI).
A total number of 224 AS patients undergoing TAVI were classified according to the 2017 staging classification into stage 0 to 4 and further dichotomized into group A (stage 0 to 2) and B (stage 3 and 4). Using the Hospital Anxiety and Depression Scale (HADS-D), patients were assigned to depressive versus non-depressive or anxious versus non-anxious per staging group respectively, and analyzed at baseline, 6 weeks, 6 months and 12 months after TAVI.
After dichotomization, 158 patients (70.5%) were assigned to group A and 66 patients (29.5%) to group B. The part showing pathologic values for depression was 25.4% (57/224 patients) in the entire collective, 26.6% (42/158 patients) in group A and 22.7% (15/66 patients) in group B ( = n.s.). The proportion showing pathologic values for anxiety was 26.8% (60/224 patients) in the entire collective and did not differ between group A (24.7%, 39/158 patients) and B (31.8%, 21/66 patients) ( = n.s.). In patients revealing pathologic values for depression or anxiety prior to TAVI, there were significant and stable improvements over time observable already in short-term (6 weeks) follow-up in group A, and likewise, but later, in long-term (6/12 months) follow-up in group B.
Although of proven prognostic relevance, higher stages of extra-valvular cardiac damage are not associated with higher rates of pre-existing depression or anxiety. The TAVI procedure resulted in a persisting reduction of depression and anxiety in patients showing pathologic values at baseline. Notably, these improvements are timely delayed in higher stages.
抑郁症和焦虑症经常出现，并且可能与主动脉瓣狭窄（AS）等心脏病的严重程度相关。鉴于已引入AS中心外心脏损伤的分期分类并显示其具有预后相关性，这一点似乎值得关注。
本研究旨在调查经导管主动脉瓣植入术（TAVI）后抑郁症和焦虑症与分期的相关性及其动态变化。
根据2017年分期分类，将总共224例接受TAVI的AS患者分为0至4期，并进一步分为A组（0至2期）和B组（3至4期）。使用医院焦虑抑郁量表（HADS-D），分别根据每个分期组将患者分为抑郁与非抑郁或焦虑与非焦虑，并在TAVI后基线、6周、6个月和12个月进行分析。
二分法分组后，158例患者（70.5%）被分配到A组，66例患者（29.5%）被分配到B组。在整个队列中，显示抑郁病理值者占25.4%（57/224例患者），A组为26.6%（42/158例患者），B组为22.7%（15/66例患者）（P=无统计学意义）。显示焦虑病理值者在整个队列中占26.8%（60/224例患者），A组（24.7%，39/158例患者）和B组（31.8%，21/66例患者）之间无差异（P=无统计学意义）。在TAVI前显示抑郁或焦虑病理值的患者中，A组在短期（6周）随访中即可观察到随时间有显著且稳定的改善，B组在长期（6/12个月）随访中也有类似但较晚出现的改善。
尽管已证实具有预后相关性，但心外心脏损伤的更高分期与既往抑郁症或焦虑症的更高发生率无关。TAVI手术使基线时显示病理值的患者的抑郁和焦虑持续减轻。值得注意的是，这些改善在更高分期中出现延迟。
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