Depression is the strongest predictor of long-term outcome in patients with chronic nonischemic heart failure
Bożena Szyguła-Jurkiewicz1, Michał Zakliczyński2, Michał Ploch3
13 Chair and Clinical Department of Cardiology, Medical University of Silesia, Silesian Center for Heart Diseases, Zabrze, Poland.
Insights
Depression and elevated hs-CRP levels are key risk factors for major adverse cardiac events in chronic heart failure patients. These findings highlight the importance of managing depression and inflammation for better cardiac outcomes.
Area of Science:
- Cardiology
- Internal Medicine
- Psychiatry
Background:
- Chronic heart failure (CHF) remains a significant clinical challenge with poor patient outcomes despite medical advancements.
- Identifying risk factors for adverse cardiac events is crucial for improving prognosis in CHF patients.
Purpose of the Study:
- To identify predictors of major adverse cardiac events (MACE) over a three-year follow-up period.
- To investigate risk factors in patients with chronic heart failure (CHF) of non-ischemic origin.
Main Methods:
- A prospective study included 199 hospitalized patients with stable CHF (LVEDD > 57 mm; LVEF < 40%) and symptom duration > 6 months.
- Exclusion criteria encompassed various comorbidities including diabetes, kidney disease, and active inflammatory conditions. Depression was assessed using standardized scales and ICD-10 criteria.
- A three-year clinical follow-up was conducted to monitor MACE, defined as death, transplantation, ventricular assist device implantation, or hospitalization.
Main Results:
- Depression was diagnosed in 30% of the study cohort.
- Independent risk factors for MACE included depression (HR: 2.26), E/A index (HR: 1.31), right ventricular dimension (HR: 1.06), high-sensitivity C-reactive protein (hs-CRP) level (HR: 1.06), and alkaline phosphatase activity (HR: 1.01).
- All identified factors were statistically significant (p < 0.05).
Conclusions:
- Depression is a significant independent predictor of MACE in patients with non-ischemic CHF.
- Biomarkers such as hs-CRP and alkaline phosphatase, along with echocardiographic parameters like the E/A index and right ventricular dimension, also contribute to predicting adverse outcomes.
- These findings underscore the multifactorial nature of CHF prognosis and the need for integrated management strategies.
Introduction:
Despite advances in medicine, chronic heart failure (CHF) still remains a significant clinical problem associated with poor outcome.
Aim Of The Study:
To determine risk factors for major adverse cardiac events (MACE) in three-year follow-up in patients with CHF of nonischemic etiology.
Material And Methods:
The prospective study included consecutive hospitalized patients with stable CHF (LVEDD > 57 mm; LVEF < 40%) and symptom duration > 6 months. Study exclusion criteria were: serious neurological and/or psychiatric diseases, stenoses in epicardial coronary arteries in coronarography, active myocarditis confirmed by myocardial biopsy, diseases of the respiratory system with pulmonary hypertension, presence of heart defects, neoplastic or connective tissue disease, documented infectious diseases at least three months before inclusion in the study, diabetes, liver cirrhosis, chronic kidney disease (eGFR < 30 ml/min/1.73 m(2)), alcoholism, planned heart transplantation. Depression severity was assessed with the Beck and the Hamilton Scales. Depression was diagnosed based on the ICD-10 criteria. Clinical follow-up began on admission and lasted three years.
Results:
The analysis encompassed 199 patients aged 49 (41-54), who met the inclusion/exclusion criteria. Depression was diagnosed in 30% of the patients. Independent factors increasing the risk of MACE (death, transplantation, ventricular assist device, hospitalization) were: depression (HR: 2.26; p < 0.001), E/A index (HR: 1.31; p < 0.01), right ventricular dimension (HR: 1.06; p < 0.01), hsCRP level (HR: 1.06; p < 0.01) and alkaline phosphatase activity in blood serum (HR: 1.01; p < 0.05).
Conclusions:
Factors affecting 3-year outcome are: depression, right ventricular dimension, the E/A index, alkaline phosphatase activity and the level of high-sensitivity C-reactive protein (hs-CRP).
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