Myocardial Alterations in Major Depressive Disorder with Anxious Distress: Evidence from Oxygenation-Sensitive CMR...

Patients with major depressive disorder with anxious distress (MDD-A) frequently experience cardiovascular symptoms (CVS), which are associated with impaired quality of life and poorer long-term prognosis. This study aimed to quantitatively evaluate myocardial alterations in MDD-A patients using oxygenation-sensitive cardiovascular magnetic resonance (OS-CMR) and mapping-derived entropy analysis, and to explore their associations with CVS as well as the severity of depressive and anxiety symptoms.

In this prospective study, 58 consecutively enrolled medication-naïve patients with MDD-A diagnosed according to DSM-5 criteria and 61 healthy controls were included. All participants underwent CMR examinations at 3.0T. Left ventricular (LV) function, native T1 and T2 values, T1-entropy and T2-entropy, LV strain parameters, and oxygenation-sensitive signal intensity change (OS-SI%) were measured and compared between the two groups. Associations between CMR-derived parameters and CVS, anxiety symptom severity, and depressive symptom severity were assessed separately. A p value < 0.05 was considered statistically significant.

Compared with healthy controls, patients with MDD-A exhibited significantly higher T1-entropy (8.3 ± 0.3 vs. 7.5 ± 0.3, p < 0.001) and T2-entropy (9.2 ± 0.4 vs. 8.1 ± 0.3, p < 0.001), whereas OS-SI% was significantly lower (11.4 ± 7.5% vs. 14.5 ± 4.5%, p = 0.007). After adjustment for age, sex, smoking status, and heart rate, multivariable regression analyses revealed that OS-SI% was inversely associated with HAMD scores (β = -0.205, p = 0.043) and HAMA scores (β = -0.453, p < 0.001), and inversely associated with CVS (OR= 0.801, p = 0.002). T1-entropy (β = 4.105, p = 0.022) and T2-entropy (β = 2.793, p = 0.042) were positively associated with HAMD scores.

OS-SI% and mapping-derived myocardial entropy measures may serve as valuable noninvasive imaging biomarkers for assessing early myocardial alterations in patients with MDD-A.