18F-FDG PET/CT brain glucose metabolism as a marker of different types of depression comorbidity in chronic systolic heart failure patients

Abstract

Background/Introduction Depression comorbidity is an important issue in heart failure (HF) disease. Results from the recent prospective randomized trial MOOD-HF did not provide a rationale for the indiscriminate use of antidepressants in depressed HF patients. Purpose The study investigated whole-brain and regional-brain glucose metabolism in HF patients with 18F-FDG PET/CT and its association with depression comorbidity. Methods Twenty-nine hospitalized patients with symptomatic systolic HF disease (LVEF<40%), NYHA class II-IV and mean age of 55.5±12.0 years participated in the study. All patients had echocardiography, blood sampling, HF-adapted and psychometric questionnaires before discharge and a brain 18F-FDG PET/CT scan after discharge. Semi-automated PET/CT image analysis was performed on all patients and 30 matched controls. The metabolic index SUVmean was calculated for the whole-brain and three brain regions (prefrontal cortex, amygdala and hippocampus), implicated in depression pathogenesis. A standardized SUVmean was also estimated by dividing depression-related regional-brain SUVmean with the whole-brain SUVmean. Results HF patients had lower average whole-brain SUVmean (3.90±1.49 vs 5.10±1.35, p=0.001), average regional-brain SUVmean (4.57±2.31 vs 9.96±3.58, p<0.001) and average standardized SUVmean (1.28±0.60 vs 2.07±1.32, p<0.001) compared to controls. Whole-brain SUVmean had a statistically significant correlation to patient age (r=−0.39, p=0.031), NYHA class (p=0.027), LVEF in the major group of 21 NYHA III-IV patients (p=0.018), diabetes comorbidity (p=0.001), creatinine levels (r=−0.49, p=0.005) and depression (r=−0.36, p=0.049). Regional-brain SUVmean was correlated to whole-brain SUVmean (r=0.53, p=0.002) and depression (r=0.46, p=0.011). The standardized SUVmean, in particular, was found to be a robust index that could differentiate HF patients with “epiphenomenal” (>0.93) or “real” (≤0.93) depression. Conclusion HF patients with more severe disease showed whole-brain and regional-brain hypometabolism in 18F-FDG PET/CT scan, which is consistent with impaired cerebral perfusion. Depressed HF patients (Beck Depression Inventory score >13) exhibited different metabolic patterns that could be used to differentiate between “epiphenomenal” and “real” depression. Namely, presence of whole-brain hypometabolism suggested “epiphenomenal” depression. Absence of whole-brain hypometabolism suggested “real” depression. When the pattern of whole-brain hypometabolism included significant relative, depression-related regional hypometabolism (standardized SUVmean ≤0.93), “real” depression was the most likely diagnosis. The distinction is important, as different types of comorbid depression suggest different treatment approach. Summarizing figure Funding Acknowledgement Type of funding source: None

Cerebral hypometabolism mediates the effect of stroke volume on cognitive impairment in heart failure patients

“…32,33 Previous work has reported associations between depression, reduced systolic function, and hypometabolism in specific brain regions in HF patients, including the amygdala and hippocampus. 23 Unexpectedly, we found that HF patients had similar anxiety and depression scores compared with normal controls, which was likely due to the relatively preserved ejection fraction in our study population (LVEF = 45%), as the severity of HF was associated with depression in patients with HF. 34 In addition, our results showed hypometabolism in cognitive-related brain regions in HF patients, suggesting that cognitive impairment may precede anxiety and depression in the early stage of HF.…”

“…Previous studies used the region of interest analysis method based on a standard template or manual delineation to explore the hypometabolism brain regions in HF patients. 23 In the present study, we performed a whole-brain voxel-wise analysis by combination of FDG PET and high-resolution T1WI images to comprehensively map brain metabolism. We found that the hypometabolic cluster overlaps with the cluster of structural alterations in patients with HF and covers other cognition-related regions, including the caudate nucleus, precuneus, PCC, calcarine cortex, lingual cortex, and olfactory cortex.…”

Prognostic value of post-discharge depression in patients recently hospitalized with acute heart failure

“…Theoretically, patients with stable and chronic HF may be more similar to the general population (31). Conversely, in patients recently hospitalized with acute HF, secondary depression due to severe somatic disorders (32) may surpass the effects of a higher BMI and younger age. In this study, COPD and diabetes mellitus were independent predictors of post-discharge depression.…”