Depression Associated with Reduced Heart Rate Variability Predicts Outcome in Adult Congenital Heart Disease

Abstract

In adult congenital heart disease (ACHD), major depressive disorder (MDD) represents a frequent comorbidity. In non-CHD, adverse outcome is predicted by MDD and heart rate variability (HRV), whereas in ACHD their prognostic relevance is unknown. We prospectively evaluated 171 patients (age 35.6 ± 11.4 years; male 42.7%, mean observation time 54.7 ± 14.9 months). Binary regression analysis calculated the association between MDD and HRV. Cox proportional survival analysis estimated their impact on decompensated heart failure and all-cause mortality (HF/death), supraventricular and ventricular tachycardia (SVT/VT), and hospitalization due to unexpected cardiac causes. Exclusively MDD with moderate/severe symptoms showed significantly lower HRV as derived from frequency-domain analysis (Symindex) (p = 0.013). In multivariate Cox regression analysis, patients stratified according to the lower quartile of the Symindex comorbid with MDD (n = 16) exhibited poorer prognosis regarding HF/death (Hazard Ratio (HR): 7.04 (95%CI:(1.87–26.5)), SVT/VT (HR: 4.90 (95%CI:1.74–9.25)) and hospitalization (HR: 3.80 (95%CI:1.36–10.6)). An additional independent predictor was N-terminal pro-B-type natriuretic peptide elevation (p < 0.001), indicating advanced HF and heart disease complexity (p < 0.001). Autonomic nervous system dysfunction measured by altered HRV is considered to be one of the pathways linking MDD and adverse outcomes in cardiac diseases. Our results exceed the existing literature by demonstrating that MDD with decreased HRV is associated with poorer prognosis in ACHD.

Psychological and Psychopharmacological Interventions in Psychocardiology

“…Psychotherapy, in particular cognitive behavioral therapy (CBT), is established in the treatment of most major mental disorders, and is also applied to treat patients with mental disorders in the context of an underlying physical disease as well as in cardiometabolic disorders themselves ( 90 , 159 – 163 ). In particular, adjustment disorder, anxiety and depressive disorders are frequent comorbidities in CVD, leading to decreased quality of life and in part worsen the disease course of the underlying physical illness ( 164 – 166 ).…”

Impact of COVID-19 on Medical Supply in Adults With Congenital Heart Disease

“…Stress response in anxiety and depression disorders provoke catecholamine related dysregulation of the autonomic nervous resulting in blunted heart rate response, higher heart rate at rest and increased QT-c variability ( 23 ). We recently published that ACDH patients with reduced heart rate variability comorbid with depression have a particularly high risk to develop heart failure/all-cause mortality, arrhythmias and unexpected hospitalization due to cardiac causes ( 30 ). In non-congenital heart disease, anxiety disorders have been linked to the onset of arrhythmias ( 31 – 33 ).…”

Psychokardiologische Aspekte bei Erwachsenen mit angeborenem Herzfehler (EMAH)

“…Herzinsuffizienz und Depressionen weisen pathophysiologisch eine gemeinsame Endstrecke, die Hypothalamus-Hypophysen-Nebennierenrinden-Achse, auf, die auf einer Interaktion multipler regulativer Prozesse, die auch das autonome Nervensystem umfassen, beruht. Eine prospektive Studie konnte belegen, dass das Vorliegen einer Depression, zusammen mit einer verminderten Herzfrequenzvariabilität als Biomarker einer autonomen Dysfunktion, mit einer erhöhten Mortalität assoziiert ist [10].…”