מתוך medicontext.co.il
By Karla Gale
WESTPORT, CT (Reuters Health) – Autonomic dysfunction as reflected by reduced heart rate variability may be the mechanism by which depression increases the risk for cardiac mortality in post-MI patients, investigators report in the October 23rd issue of Circulation: Journal of the American Heart Association.
Dr. Robert M. Carney, of the Washington University School of Medicine in St. Louis, and colleagues evaluated patients screened for the Enhancing Recovery in Coronary Heart Disease (ENRICHD) clinical trial who had experienced an acute MI within the previous 28 days. Included were 307 patients with depression, as manifested by Beck Depression Inventory scores of 10 or higher, and 366 patients without depression.
Tapes from ambulatory ECG monitoring were analyzed for heart rate variability (HRV), which the investigators point out is "a widely used method for studying cardiac autonomic modulation." Results showed that patients with depression exhibited significantly lower log-transformed indices of HRV than did their nondepressed counterparts.
After adjusting for age, sex, diabetes, and current cigarette smoking, depression remained significantly associated with three of four indices of heart rate variability.
"For a number years we've been trying to understand what it is about depression that increases the risk for cardiac morbidity and mortality," Dr. Carney told Reuters Health.
"For example, smoking is much more common in depressed patients than in nondepressed patients," he explained. "And smoking also affects HRV, so we've never known for sure whether it's confounders like smoking we're really looking at or if it's depression."
Based on his team's findings, Dr. Carney said, "I think we can now say that it is depression that is responsible for the lower HRV. As a result, it's more likely that lower HRV may explain most if not all of the effects of depression on mortality."
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