Humayra Syeda, Yahya Noorazrul, Ning Chai Jia, Mohd Raffali Mohd Asyiq Al-Fard Bin, Mir Imtiyaz Ali, Mohamed Abdul Latiff, Abdul Manan Hanani
Makmal Pemprosesan Imej Kefungsian (Functional Image Processing Laboratory), Department of Radiology, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
Diagnostic Imaging & Radiotherapy Program, School of Diagnostic & Applied Health Sciences, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
Front Cardiovasc Med. 2025 Apr 1;12:1439520. doi: 10.3389/fcvm.2025.1439520. eCollection 2025.
Depression is a significant comorbidity linked to poor subjective and objective health outcomes in cardiac patients. The paucity of data necessitates further research to elucidate the pathophysiological connection between depression and cardiac diseases in the presence of N-terminal pro-brain natriuretic peptide (NT-proBNP). Therefore, the current systematic review investigated the clinical significance of NT-proBNP as a predictive biomarker in cardiac patients with depressive symptoms.
Two researchers independently performed an extensive search of published literature from inception until April 2024 on PubMed, Web of Science, and Cochrane Library in accordance with the PRISMA guidelines. From a total of 452 records, 29 articles were eligible for full-text review, whereof, data from 14 articles were systematically collated. Based on the Newcastle-Ottawa Scale (NOS) criteria, all studies earned 6-9 stars and were of good quality.
Among a total population of 4,035, male patients were predominantly higher ( = 2,618, 65.0%). Approximately, 31.3% ( = 1,264) cardiac patients were depressed. The mean age ranged between 56 and 76 and 58-73 years for depressed vs. non-depressed individuals respectively. More than half of the patients presented with heart failure ( = 2,234, 55.4%), followed by acute myocardial infarction ( = 1,368, 34.0%), coronary artery disease ( = 674, 16.7%), and acute coronary syndrome ( = 164, 4.1%). Poor ventricular function (26.1 ± 6.8 to 37.65 ± 12.71) and worsened NYHA class II-III functional symptoms (moderate-marked limitations) were more prevalent in depression. In addition, three studies found that age and female gender were significant risk factors in depressed patients. Significant clinical relevance was established between increased NT-proBNP and depressive symptoms in seven studies. NT-proBNP values ranged between 138 and 12,000 pg/ml vs. 108 to 6,000 pg/ml for depressed vs. non-depressed patients.
The presence of elevated NT-proBNP in depression demonstrated adverse cardiovascular outcomes and played a crucial role in predicting the clinical prognosis. Future NT-proBNP studies with predefined follow-up period at different time intervals, and in clinically depressed patients are highly recommended.
https://www.crd.york.ac.uk/PROSPERO/, identifier (CRD42024536115).
抑郁症是一种与心脏病患者主观和客观健康状况不佳相关的重要合并症。数据的匮乏使得有必要进行进一步研究，以阐明在存在N端前脑钠肽（NT-proBNP）的情况下抑郁症与心脏病之间的病理生理联系。因此，本系统评价研究了NT-proBNP作为有抑郁症状的心脏病患者预测生物标志物的临床意义。
两名研究人员按照PRISMA指南，独立对PubMed、Web of Science和Cochrane图书馆从创刊至2024年4月发表的文献进行了广泛检索。在总共452条记录中，29篇文章符合全文审查标准，其中14篇文章的数据进行了系统整理。根据纽卡斯尔-渥太华量表（NOS）标准，所有研究均获得6-9星，质量良好。
在总共4035名研究对象中，男性患者占比更高（n = 2618，65.0%）。约31.3%（n = 1264）的心脏病患者患有抑郁症。抑郁症患者与非抑郁症患者的平均年龄分别在56至76岁和58至73岁之间。超过一半的患者患有心力衰竭（n = 2234，55.4%），其次是急性心肌梗死（n = 1368，34.0%）、冠状动脉疾病（n = 674，16.7%）和急性冠状动脉综合征（n = 164，4.1%）。抑郁症患者中，心室功能较差（26.1±6.8至37.65±12.71）和纽约心脏协会（NYHA）II-III级功能症状恶化（中度-明显受限）更为普遍。此外，三项研究发现年龄和女性性别是抑郁症患者的重要危险因素。七项研究证实NT-proBNP升高与抑郁症状之间存在显著的临床相关性。抑郁症患者与非抑郁症患者的NT-proBNP值分别在138至12000 pg/ml和108至6000 pg/ml之间。
抑郁症患者中NT-proBNP升高表明心血管预后不良，并在预测临床预后中起关键作用。强烈建议未来针对临床抑郁症患者在不同时间间隔进行有预定义随访期的NT-proBNP研究。
