Depressive Symptoms In Heart Failure Research Articles

Exo-miR-144-3p as a promising diagnostic biomarker for depressive symptoms in heart failure

The prevalence of depression is higher in heart failure (HF) patients. Early screening of depressive symptoms in HF patients and timely intervention can help to improve patients' quality of life and prognosis. This study aims to explore diagnostic biomarkers by examining the expression profile of serum exosomal miRNAs in HF patients with depressive symptoms. Serum exosomal RNA was isolated and extracted from 6 HF patients with depressive symptoms (HF-DS) and 6 HF patients without depressive symptoms (HF-NDS). High-throughput sequencing was performed to obtain miRNA expression profiles and target genes were predicted for the screened differentially expressed miRNAs. Biological functions of the target genes were analyzed through Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG). Subsequently, we collected serum exosomal RNAs from HF-DS (n=20) and HF-NDS (n=20). The differentially expressed miRNAs selected from the sequencing results were validated using reverse transcription quantitative polymerase chain reaction (RT-qPCR). Finally, the diagnostic efficacy of the differentially expressed exosomal miRNAs for HF-DS was evaluated by using receiver operating characteristic (ROC) curves. A total of 19 significantly differentially expressed exosomal miRNAs were screened by high-throughput sequencing, consisting of 12 up-regulated and 7 down-regulated exosomal miRNAs. RT-qPCR validation demonstrated that the expression level of exo-miR-144-3p was significantly down-regulated in the HF-DS group, and the expression levels of exo-miR-625-3p and exo-miR-7856-5p were significantly up-regulated. In addition, the expression level of exo-miR-144-3p was negatively correlated with the severity of depressive symptoms in HF patients, and that the area under the curve (AUC) of exo-miR-144-3p for diagnosing HF-DS was 0.763. In this study, we examined the serum exosomal miRNA expression profiles of HF patients with depressive symptoms and found that lower level of exo-miR-144-3p was associated with more severe depressive symptoms. Exo-miR-144-3p is a potential biomarker for the diagnosis of HF-DS.

Depressive Symptoms in Heart Failure: Pathophysiology and Diagnosis

Depression commonly affects individuals with heart failure and is associated with higher mortality rates, increased disability, healthcare costs, and reduced quality of life. Heart failure patients are more likely to experience depression. This study was aimed to describe pathophysiology and treatment of depression in heart failure patients. Both physiological and behavioral variables may influence the relationship between depression and the development and progression of heart failure, as well as increased rates of mortality. Because of the similarities between the symptoms of cardiac and mental illnesses, it may be difficult to make an appropriate diagnosis of depressive disorders in individuals who are suffering from heart failure. Further research is urgently needed to improve the diagnosis of these disorders and develop therapies that benefit patients with heart failure.

Determining Holistic Factors Related to Depressive Symptoms in Patients With Heart Failure.

Identifying modifiable factors associated with depressive symptoms is important to develop corresponding strategies. This study aimed to determine the holistic factors related to depressive symptoms in heart failure (HF) patients. It was a secondary analysis of a cross-sectional study. We recruited 329 hospitalized HF patients from two hospitals in China. It is found that HF patients had a relatively high proportion (28.27%) of depressive symptoms. Red blood cell distribution width (RDW) (β = .222, p = .011) and physical symptoms (β = .151, p < .001) were positively associated with depressive symptoms, whereas resilience (β = -.241, p < .01) and family functioning (β = -.288, p = .001) were negatively associated with depressive symptoms. Thus, early screening and management of depressive symptoms are warranted. RDW may serve as a marker for screening depressive symptoms. Moreover, interventions focused on relieving physical symptoms and enhancing resilience and family functioning may reduce depressive symptoms.

Prevalence of depressive symptoms in patients with Heart Failure in China: a meta-analysis of comparative studies and epidemiological surveys

Background: Although depressive symptoms is a frequent psychiatric comorbidity in people with Heart Failure (HF) in China, its prevalence was not estimated. This is a meta-analysis of studies examining depressive symptoms in HF patients in China. Methods: The following databases including PubMed, the Cochrace Library, Embase, China National Knowledge Infrastructure (CNKI), WanFang and VIP were independently and systematically searched from inception until March 31, 2019. Statistical analyses were performed using the Stata 13.0 software. The pooled prevalence of depressive symptoms was performed using a random-effects model. In addition, subgroup analysis was conducted based on the New York Heart Association (NYHA) functional class, the assessment tools of depression and gender. Results: Altogether 53 studies (10649 participants) met the inclusion criteria for the analysis. The point prevalence of depressive symptoms in HF was 43%. In subgroup analyses, the prevalence of depressive symptoms was higher in females than in males (46% vs 34%, respectively), and the prevalence of depressive symptoms positively correlated with New York Heart Association functional classes (II 28%, III 46%, IV 52%) . Rates of depression were highest when measured using BDI scale (62%), and lowest when measured using the CES-D (31%). Conclusions: This meta-analysis confirmed that the prevalence of depressive symptoms was common in HF patients in China and it is related to the severity of heart failure, gender and the diversity of assessment tools. Appropriate strategies for prevention and treatment of depressive symptoms in this population need greater attention.

Depressive Symptoms Drive Fatigue Following Congestion in Heart Failure

Background Physical and depressive symptoms in heart failure (HF) are drivers of quality of life and healthcare use. Intrathoracic impedance, an objective measure of pulmonary congestion in HF, has been associated with both physical and psychological symptoms. Little is known, however, about how intrathoracic impedance (Optivol® Index), and physical and psychological symptoms are inter-related. Objective To understand the mechanisms by which an objective measure of congestion is related to physical or depressive symptoms. Methods Adults with symptomatic HF and an Optivol device had congestion data (Optivol Index>60Ω threshold) collected over 180 days prior to completing surveys of physical symptoms (Functional Assessment of Chronic Illness Therapy-Fatigue Scale; HF Somatic Perception Scale Dyspnea and Early and Subtle Symptoms subscales) and depressive symptoms (9-item Patient Health Questionnaire). Symptoms associated with congestion were identified based on Pearson correlation (p value Results Participants (n=49) were mostly male (61%), on average 62 years old, with mainly non-ischemic (80%), NYHA Class III/IV HF (63%). Fatigue (r= 0.29) and depressive symptoms (r= 0.51) were the only symptoms correlated with congestion (p value Conclusion Optivol-detected congestion events in the previous 6 months were associated with more depressive symptoms and fatigue. Depression mediated the effects of fatigue from congestion events. Reducing congestion in HF may mitigate depression and reduce fatigue. In addition, this study highlights the importance of addressing depressive symptoms in patients with HF.

Two-Step Screening for Depressive Symptoms and Prediction of Mortality in Patients With Heart Failure.

Comorbid depression in patients with heart failure is associated with increased risk for death. In order to effectively identify depressed patients with cardiac disease, the American Heart Association suggests a 2-step screening method: administering the 2-item Patient Health Questionnaire first and then the 9-item Patient Health Questionnaire. However, whether the 2-step method is better for predicting poor prognosis in heart failure than is either the 2-item or the 9-item tool alone is not known. To determine whether the 2-step method is better than either the 2-item or the 9-item questionnaire alone for predicting all-cause mortality in heart failure. During a 2-year period, 562 patients with heart failure were assessed for depression by using the 2-step method. With the 2-step method, results are considered positive if patients endorse either depressed mood or anhedonia on the 2-item screen and have scores of 10 or higher on the 9-item screen. Screening results with the 2-step method were not associated with all-cause mortality. Patients with scores positive for depression on either the 2-item or 9-item screen alone had 53% and 60% greater risk, respectively, for all-cause death than did patients with scores negative for depression after adjustments for covariates (hazard ratio, 1.530; 95% CI, 1.029-2.274 for the 2-item screen; hazard ratio, 1.603; 95% CI, 1.079-2.383 for the 9-item screen). The 2-step method has no clear advantages compared with the 2-item screen alone or the 9-item screen alone for predicting adverse prognostic effects of depressive symptoms in heart failure.

Depressive symptoms in heart failure: Independent prognostic factor or marker of functional status?

ObjectiveThe prognostic potential of depressive symptoms independent of somatic features of heart failure severity has repeatedly been demonstrated. However, patient-reported functional status has rarely been accounted for in these studies. Thus, it has remained unclear to what extent the predictive power of depressive symptoms may mirror functional status. We therefore aimed to evaluate the prognostic value of depressive symptoms adjusting for patient-reported functional status in a large, well-characterized sample of patients with systolic heart failure. MethodsEight hundred sixty-three patients, 67±12years old, 72% men, and 42% with New York Heart Association functional classes III/IV, who participated in the extended Interdisciplinary Network Heart Failure (INH) study were investigated. We assessed depressive symptoms using the Patient Health Questionnaire (PHQ-9) and patient-reported functional status with the Kansas City Cardiomyopathy Questionnaire (KCCQ). Data on survival was obtained after a follow-up of 18months (100% complete). ResultsDepressive symptoms predicted mortality risk (HR per PHQ-9 scale point=1.07, 95% CI 1.04–1.09, p<.001), even after adjustment for heart failure severity and co-morbidities (HR=1.04, 95% CI 1.01–1.07, p=.017). However, they were no longer significant predictors (HR=1.01, 95% CI 0.98–1.05, p=0.46) after additional adjustment for patient-reported functional status, which proved predictive of mortality risk (HR=0.90, 95% CI 0.82–0.99, p=.025). ConclusionOur results suggest that the association of depressive symptoms with functional status may at least partly explain the prognostic potential of depressive symptoms.

Patient Perspectives About Depressive Symptoms in Heart Failure

Scientists have systematically established the prevalence and the consequences of depressive symptoms in patients with heart failure (HF). However, a comprehensive understanding of patient perspectives about depressive symptoms, in combination with HF, has not been published. A patient-centered approach may support the design of interventions that are effective and acceptable to patients with HF and depressive symptoms. The aim of this study was to review qualitative findings about patient perspectives of contributing factors, associated symptoms, consequences, and self-care strategies used for depressive symptoms in HF. Qualitative studies were included if they were published between 2000 and 2012, if they were in English, and if they described emotional components about living with HF. Three electronic databases were searched using the key words heart failure, qualitative, and depression or psychosocial or stress or emotional. Thirteen studies met the inclusion criteria. Patients with HF reported that financial stressors, overall poor health, past traumatic life experiences, and negative thinking contributed to depressive symptoms. The patients described cognitive-affective symptoms of depression and anxiety but not somatic symptoms of depression. Perceived consequences of depressive symptoms included hopelessness, despair, impaired social relationships, and a decreased ability to engage in HF self-care. Recommended management strategies consisted of enhanced social support and cognitive strategies. Depressive symptoms in patients with HF were associated with a number of contributing factors, including those not specifically related to their disease, and serious consequences that reduced their self-care ability. Nonpharmacological management approaches to depressive symptoms that include improved social support or cognitive interventions may be effective and acceptable strategies.

Structural abnormality of the hippocampus and depressive symptoms in a rat model of heart failure

Purpose: Heart failure (HF) affects almost all organs in our body through reduced organ perfusion and resultant neurohumoral alterations. Major depression is more prevalent in HF patients as compared with normal subjects, suggesting the possible interaction between the heart and the brain in HF. However, the mechanism of depressive symptoms in HF remains largely unclear. Several reports showed the association between major depression and structural abnormality of the hippocampus such as grey matter reduction and decreased neurogenesis. In the present study, we thus investigated whether hippocampal grey matter reduction and decreased neurogenesis were observed in association with depressive symptoms in a rat model of HF using magnetic resonance (MR) imaging and histological analysis. Methods: Male Wistar rats were divided into two groups: HF group with permanent ligation of the left coronary artery (n=28) and sham-operated control group (n=25). Four months after the procedure, the following two studies were performed. In the first study, the HF group (n=20) and the sham group (n=17) underwent behavioral tests (open-field test and elevated plus maze test) for assessment of depressive symptoms, followed by structural brain MR image acquisition. The obtained MR images were analyzed to detect regional alterations in grey matter between the two groups as measured by grey matter probability values (a maximum value of 1). In the second study, brains of the both groups (n=8, each) were fixed for histological analysis of neurogenesis by counting the number of bromodeoxyuridine (BrdU)-immunopositive cells in the hippocampus. Results: The HF group showed significantly greater depressive symptoms as compared with the sham group, including decreased time spent in the inner zone (HF group, 4.2±0.7% vs. sham group, 8.7±1.8%, P<0.05) in open-field test and decreased time spent in the open arm (HF group, 2.5±0.6% vs. sham group, 6.6±1.5%, P<0.05) in elevated plus maze test. Analysis of structural brain MR images revealed grey matter reduction in the HF group than in the sham group in several brain regions including the bilateral hippocampus (HF group, 0.480±0.002 vs. sham group, 0.505±0.002, P<0.001). Moreover, the number of BrdU-immunopositive cells in the hippocampus was decreased in the HF group than in the sham group (HF group, 18.3±1.5 vs. sham group, 23.0±1.3, P<0.05). Conclusions: The present study demonstrates for the first time that HF induces structural abnormality of the hippocampus such as grey matter reduction and decreased neurogenesis in association with depressive symptoms.

Social Connections and Depressive Symptoms in Heart Failure

Introduction: There are no instruments that measure health-related quality of life (HRQOL) after mechanical circulatory support (MCS). As part of our MCS HRQOL instrument development research project, we report on two domains of HRQOL: physical function/role performance and social interaction/support.Methods:We conducted semi-structured interviews with 24 MCS patients (125bridge to transplant [BTT] and 125destination therapy [DT]) both early and later after implant. Interviews lasted 30-60 minutes and were audio-recorded and transcribed verbatim. Using qualitative methodology, data were analyzed using a 2-phase coding strategy. Results: As heart failure symptoms abate post MCS, patients gradually increase their physical function, mobility, and ambulation. Some patients described MCS as cumbersome and interfering with functional activities (requiring stooping down and bending over) and basic activities of daily living (dressing, showering, and toileting). After hospital discharge, they re-introduced more active home management and leisure activities, although they identified hassles and limitations with resumption of more strenuous activities (e.g., mowing the lawn, handyman work, gardening, and bicycling). Resumption of work and sexual intimacy were identified as particularly challenging, and life span issues influenced expectations and satisfaction with limitations in these areas. Adaptation to MCS self-care increased over time; carrying equipment was a hassle and related to neck and back discomfort. Social interaction after discharge was influenced by pre-morbid habits, expectations, and adaptability (e.g., more planning needed to go out and need for a caregiver). Most patients were satisfied with support of MCS self-care; although some patients identified caregivers as being too overprotective and desired more privacy. Patients typically felt useful, but also often perceived themselves to be a burden on their families. Conclusions: The early post-MCS implant period is one of tremendous physical and social adjustment. Over time, MCS patients increase physical activities and social interaction, while acknowledging hassles and limitations related to MCS. These data will inform development of an instrument to measure MCS HRQOL.

Depressive Symptoms in Heart Failure: What is the Relationship with Inflammation and Fibrosis?

Depressive Symptoms in Heart Failure: What is the Relationship with Inflammation and Fibrosis?

Depressive symptoms are common and associated with adverse clinical outcomes in heart failure with reduced and preserved ejection fraction

Little is known about depressive symptoms in heart failure with preserved ejection fraction (HFpEF, EF ≥50%). We aimed to assess the prevalence of depression, to clarify the impact of depressive symptoms upon clinical outcomes, and to identify factors associated with these symptoms in HF with reduced EF (HFrEF, EF <50%) and HFpEF. A total of 106 HF outpatients were enrolled. Of them, 61 (58%) had HFpEF. Most patients were male (HFrEF 80%, HFpEF 70%) and the mean of plasma B-type natriuretic peptide (BNP) level in the HFrEF group was similar to that in the HFpEF group (164.8 ± 232.8 vs. 98.7 ± 94.8 pg/mL). HFrEF patients were treated more frequently with beta-blockers compared with HFpEF patients (71% vs. 43%, p=0.004). Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale (CES-D). The prevalence of depression (CES-D score ≥16), and CES-D score did not significantly differ between HFrEF and HFpEF (24% vs. 25%, 14.1 ± 8.3 vs. 12.1 ± 8.3, respectively). During the 2-year follow-up, depressed patients had more cardiac death or HF hospitalization in HFrEF (55% vs. 12%, p=0.002) and HFpEF (35% vs. 11%, p=0.031). Cox proportional hazard analysis revealed that a higher CES-D score, indicating increased depressive symptoms, predicted cardiac events independent of BNP in HFrEF [hazard ratio (HR) 1.07, 95% confidence interval (CI) 1.01-1.13] and HFpEF (HR 1.09, 95% CI 1.04-1.15). Multiple regression analyses adjusted for BNP showed that independent predictors of depressive symptoms were non-usage of beta-blockers and being widowed or divorced in HFrEF. On the other hand, usage of warfarin was the only independent risk factor for depressive symptoms in HFpEF (all, p<0.05). Depressive symptoms are common and independently predict adverse events in HFrEF/HFpEF patients. This study suggests that beta-blockers reduce depressive symptoms in HFrEF. In contrast, treatment for depression remains to be elucidated in HFpEF.

DEPRESSIVE SYMPTOMS ARE COMMON AND ASSOCIATED WITH ADVERSE CLINICAL OUTCOMES IN HEART FAILURE WITH REDUCED AND PRESERVED EJECTION FRACTION: THE DIFFERENTIAL RELEVANCE OF BETA-BLOCKERS FOR REDUCING DEPRESSIVE SYMPTOMS

Little is known about depressive symptoms in heart failure with preserved ejection fraction (HFpEF, EF =50p). We aimed to assess the prevalence of depression, to clarify the impact of depressive symptoms upon clinical outcomes, and to identify factors associated with these symptoms in HF with

Measuring Depressive Symptoms in Heart Failure: Validity and Reliability of the Patient Health Questionnaire-8

Depressive symptoms are common in patients with heart failure, but few investigators have reported the validity and reliability of measures of depressive symptoms among these patients. To evaluate the validity and reliability of a measure of depressive symptoms, the Patient Health Questionnaire-8 (PHQ-8), among 249 patients with chronic heart failure. As part of a larger study, patients completed the PHQ-8 and the Living With Heart Failure Questionnaire. New York Heart Association class was assessed as a measure of the severity of heart failure. Construct validity of the PHQ-8 was evaluated by confirmatory factor analysis, Pearson correlation coefficients, and analysis of variance. Internal consistency reliability was estimated by using the Cronbach α. The sample was 63% men, with a mean age of 63 years, and 67% reported their race as white. Construct validity of the PHQ-8 was supported. The confirmatory factor analysis model reflected the emotional and somatic dimensions of depressive symptoms and displayed a good fit with the data. The χ(2) value of the PHQ-8 was 24.75 with 18 degrees of freedom (P =.13) and the goodness-of-fit index was 0.98. The PHQ-8 was significantly correlated with the total and subscale scores on the Living With Heart Failure Questionnaire (P <.001 for all correlations). Differences in the PHQ-8 scores were found among New York Heart Association classes (F=20.4, P<.001). The PHQ-8 internal consistency reliability (Cronbach α) was 0.82. The PHQ-8 demonstrated satisfactory validity and reliability; these results support its use to measure depressive symptoms in patients with heart failure.

Gender Is Not Associated with Depressive Symptoms in Heart Failure

Gender Is Not Associated with Depressive Symptoms in Heart Failure

Association between major depressive symptoms in heart failure and impaired regional cerebral blood flow in the medial temporal region: a study using 99m Tc-HMPAO single photon emission computerized tomography (SPECT)

Depressive symptoms are frequently associated with heart failure (HF), but the brain mechanisms underlying such association are unclear. We hypothesized that the presence of major depressive disorder (MDD) emerging after the onset of HF would be associated with regional cerebral blood flow (rCBF) abnormalities in medial temporal regions previously implicated in primary MDD, namely the hippocampus and parahippocampal gyrus. Using 99mTc-SPECT, we measured rCBF in 17 elderly MDD-HF patients, 17 non-depressed HF patients, and 18 healthy controls, matched for demographic variables. Group differences were investigated with Statistical Parametric Mapping. Significant rCBF reductions in MDD-HF patients relative to both non-depressed HF patients and healthy controls were detected in the left anterior parahippocampal gyrus and hippocampus (ANOVA, p=0.008 corrected for multiple comparisons) and the right posterior hippocampus and parahippocampal gyrus (p=0.005 corrected). In the overall HF group, there was a negative correlation between the severity of depressive symptoms and rCBF in the right posterior hippocampal/parahippocampal region (p=0.045 corrected). These findings are consistent with the notion that the medial temporal region is vulnerable to brain perfusion deficits associated with HF, and provide evidence that such functional deficits may be specifically implicated in the pathophysiology of MDD associated with HF.

The distressed (type D) personality is independently associated with impaired health status and increased depressive symptoms in chronic heart failure

Chronic heart failure (CHF) is a serious condition that is associated with impaired health status and a high prevalence of depressive symptoms. To date, little is known about the determinants of health status and depressive symptoms in CHF. Therefore, the aim of this study was to assess whether Type D personality is associated with impaired health status and increased depressive symptoms in heart failure patients, independent of disease characteristics. Eighty-four patients (63 men and 21 women, mean age=65.9+/-12.1 years) with systolic CHF completed four questionnaires to assess Type D personality (14-item Type D Personality Scale [DS14]), health status (Minnesota Living with Heart Failure Questionnaire [MLWHFQ]), depressive symptoms (Center for Epidemiological Studies Depression Scale [CES-D]) and mood status (Global Mood Scale [GMS]) when visiting an outpatient heart failure clinic. Information on clinical variables was obtained from patients' medical records. Type D patients were more likely to experience impairment in health status (18/38=47%) as compared to non-Type Ds (11/46=24%), P=0.027. They also more often reported symptoms of depression; namely 18 of 38=47% versus 6 of 46=13%, P=0.001. When controlling for severity and etiology of CHF, age and gender, Type D remained a significant associate of impaired health status [odds ratio (OR) 3.0, 95% confidence interval (CI) 1.12-7.78] and depressive symptoms (OR 6.3, 95% CI 2.08-19.12). Type D was associated with impaired health status and increased depressive symptoms in CHF patients. These preliminary findings demonstrate the value of including personality factors in CHF research.