Relationship Between Depression and Subclinical LV Changes
Relationship Between Depression and Subclinical LV Changes
Objective Individuals with depression are at risk of heart failure. This study was designed to elucidate the relationship between depression and subclinical left ventricular (LV) changes in the general Korean population.
Design Cross-sectional cohort study.
Setting University hospital.
Patients A total of 2420 participants, aged 40–79 years, without known cardiovascular disease, were recruited from the Korean Genome Epidemiology Study.
Methods All individuals underwent conventional two-dimensional echocardiography and tissue Doppler imaging (TDI) to measure LV changes. In addition, subjects answered the Beck depression inventory I (BDI-I) questionnaire to assess depression levels. Participants were assigned to one of three groups based on the BDI-I score: no depression (0≤ BDI-I <10), mild depression (10≤ BDI-I <20), and moderate to severe depression (BDI-I ≥20).
Results LV diastolic function parameters, such as the transmitral A wave velocity and E/A ratio, TDI early diastolic velocity (Ea), and E/Ea ratio, were progressively altered across the levels of depression (all p<0.01). After multivariate adjustment, subjects with moderate to severe depression showed a significantly higher LV mass index (p=0.019) and lower TDI Ea velocity (p=0.006) compared with those without depression. In linear regression models, the presence of depression (BDI-I ≥10) was independently associated with a lower TDI Ea velocity (p=0.004).
Conclusions Individuals with moderate to severe depression showed subclinical alterations in LV structure and function. These findings support the hypothesis that clinical depression may be an independent risk factor for the development of cardiovascular disease.
Depression is common in patients with cardiovascular disease (CVD), and 14%–50% of patients with CVD have some degree of depression. Previous cohort studies have shown that individuals with depressive symptoms are at an increased risk of developing coronary artery disease (CAD). In addition, depression has been found to be a predictor of poor prognosis in patients with pre-existing heart disease, including congestive heart failure, atrial fibrillation, angina pectoris and myocardial infarction.
Although the pathobiological mechanism linking depression with CVD has not been clearly elucidated, it seems likely that a variety of biobehavioural pathways are involved in the connections between these disease entities. In addition to biobehavioural pathways, it has been hypothesised that cardiac structural or functional changes might precede the development of clinical symptoms in patients with depression. Considering that left ventricular (LV) diastolic dysfunction is the first step in the ischaemic cascade and the earliest manifestation of diverse cardiomyopathy, it is possible that subclinical LV diastolic dysfunction may be observed in patients with depression. However, few studies have examined the relationship between LV systolic/diastolic function and depression using conventional two-dimensional (2D) echocardiography, and no previous study has reported a significant relationship between depression and cardiac disease severity.
Tissue Doppler imaging (TDI) has emerged as a useful tool for the early detection of myocardial systolic and diastolic dysfunction in addition to its use as a prognosticator for CVD. Until recently, no epidemiologic data has explored the relationship between depression and LV functional changes using TDI.
Using a sensitive echocardiographic TDI technique in the general Korean population, we conducted a cross-sectional analysis to investigate the relationship between depression and subclinical LV changes.
Abstract and Introduction
Abstract
Objective Individuals with depression are at risk of heart failure. This study was designed to elucidate the relationship between depression and subclinical left ventricular (LV) changes in the general Korean population.
Design Cross-sectional cohort study.
Setting University hospital.
Patients A total of 2420 participants, aged 40–79 years, without known cardiovascular disease, were recruited from the Korean Genome Epidemiology Study.
Methods All individuals underwent conventional two-dimensional echocardiography and tissue Doppler imaging (TDI) to measure LV changes. In addition, subjects answered the Beck depression inventory I (BDI-I) questionnaire to assess depression levels. Participants were assigned to one of three groups based on the BDI-I score: no depression (0≤ BDI-I <10), mild depression (10≤ BDI-I <20), and moderate to severe depression (BDI-I ≥20).
Results LV diastolic function parameters, such as the transmitral A wave velocity and E/A ratio, TDI early diastolic velocity (Ea), and E/Ea ratio, were progressively altered across the levels of depression (all p<0.01). After multivariate adjustment, subjects with moderate to severe depression showed a significantly higher LV mass index (p=0.019) and lower TDI Ea velocity (p=0.006) compared with those without depression. In linear regression models, the presence of depression (BDI-I ≥10) was independently associated with a lower TDI Ea velocity (p=0.004).
Conclusions Individuals with moderate to severe depression showed subclinical alterations in LV structure and function. These findings support the hypothesis that clinical depression may be an independent risk factor for the development of cardiovascular disease.
Introduction
Depression is common in patients with cardiovascular disease (CVD), and 14%–50% of patients with CVD have some degree of depression. Previous cohort studies have shown that individuals with depressive symptoms are at an increased risk of developing coronary artery disease (CAD). In addition, depression has been found to be a predictor of poor prognosis in patients with pre-existing heart disease, including congestive heart failure, atrial fibrillation, angina pectoris and myocardial infarction.
Although the pathobiological mechanism linking depression with CVD has not been clearly elucidated, it seems likely that a variety of biobehavioural pathways are involved in the connections between these disease entities. In addition to biobehavioural pathways, it has been hypothesised that cardiac structural or functional changes might precede the development of clinical symptoms in patients with depression. Considering that left ventricular (LV) diastolic dysfunction is the first step in the ischaemic cascade and the earliest manifestation of diverse cardiomyopathy, it is possible that subclinical LV diastolic dysfunction may be observed in patients with depression. However, few studies have examined the relationship between LV systolic/diastolic function and depression using conventional two-dimensional (2D) echocardiography, and no previous study has reported a significant relationship between depression and cardiac disease severity.
Tissue Doppler imaging (TDI) has emerged as a useful tool for the early detection of myocardial systolic and diastolic dysfunction in addition to its use as a prognosticator for CVD. Until recently, no epidemiologic data has explored the relationship between depression and LV functional changes using TDI.
Using a sensitive echocardiographic TDI technique in the general Korean population, we conducted a cross-sectional analysis to investigate the relationship between depression and subclinical LV changes.
