ABSTRACT
FUNDAMENTO: Tem-se observado que a depressão é preditora de reinternação e mortalidade na insuficiência cardíaca. O hormônio da paratireoide é um biomarcador novo e promissor que pode predizer a internação, a capacidade funcional e a mortalidade na insuficiência cardíaca. OBJETIVO: Nosso objetivo foi investigar a associação da depressão aos níveis séricos de hormônio da paratireoide em pacientes com insuficiência cardíaca sistólica. MÉTODOS: Cem pacientes ambulatoriais consecutivos com IC sistólica com fração de ejeção do ventrículo esquerdo < 40% foram examinados prospectivamente. Todos os pacientes foram submetidos a exames laboratoriais, incluindo análises de peptídeo natriurético cerebral e de hormônio da tireoide. Os pacientes foram convidados a completar o Inventário de Depressão de Beck-II. RESULTADOS: Cinquenta e um pacientes (51%) apresentavam escore de BDI ruim (escore de BDI > 18). Esses pacientes apresentavam níveis de hormônio da paratireoide significativamente mais elevados em comparação com aqueles com bons escores de BDI (133 ± 46 pg/ml versus 71 ± 26 pg/ml, p < 0,001). No modelo de regressão logística multivariada, constatou-se que o nível do hormônio da tireoide (razão de chances (OR) = 1.035, p = 0,003), fração de ejeção do ventrículo esquerdo (OR = 0,854, p = 0,004), classe funcional III / IV (OR = 28,022, p = 0,005), C-reactive protein (CRP) (OR = 1,088, p = 0,020) e presença de edema pré-tibial (OR = 12,341, p = 0,033) constituíam preditores independentes de depressão moderada a importante após o ajuste de outros possíveis fatores de confusão. CONCLUSÃO: Pacientes com insuficiência cardíaca sistólica com depressão moderada a importante apresentavam níveis séricos elevados de hormônio da tireoide e CRP, capacidade funcional ruim e fração de ejeção do ventrículo esquerdo mais baixa. A associação da depressão com esses parâmetros pode explicar a contribuição da depressão para a internação e a mortalidade na insuficiência cardíaca.
BACKGROUND: Depression has been found to be a predictor of rehospitalization and mortality in heart failure (HF). Parathyroid hormone (PTH) is a novel promising biomarker that can predict hospitalization, functional status and mortality in HF. OBJECTIVE: We aimed to investigate the association of depression with serum PTH levels in patients with systolic HF. METHODS: A total of consecutive 100 outpatients with systolic HF having left ventricular ejection fraction (LVEF) < 40%, were prospectively studied. All patients underwent laboratory tests, including brain natriuretic peptide (BNP) and PTH analyses. The patients were asked to complete the Beck Depression Inventory- II (BDI). RESULTS: Fifty-one patients (51%) were shown to have poor BDI score (BDIS > 18). Patients with poor BDI score had significantly higher PTH levels compared to those with good BDIS (133 ± 46 pg/ml vs. 71 ± 26 pg/ml, p < 0.001). In multivariable logistic regression model, PTH level (Odds ratio (OR) = 1.035, p = 0.003), LVEF (OR = 0.854, p = 0.004), NYHA functional class III/IV (OR = 28.022, p = 0.005), C-reactive protein (CRP) (OR = 1.088, p = 0.020), and presence of pretibial edema (OR = 12.341, p = 0.033) were found to be independent predictors of moderate to severe depression after adjustment of other potential confounders. CONCLUSION: Systolic HF patients with moderate to severe depression had higher serum levels of PTH and CRP, poor functional status and lower LVEF. The association of depression with such parameters might explain the contribution of depression to hospitalization and mortality in HF.
Subject(s)
Aged , Female , Humans , Male , Middle Aged , Depression/blood , Heart Failure, Systolic/blood , Parathyroid Hormone/blood , Biomarkers/blood , C-Reactive Protein/analysis , Depression/physiopathology , Heart Failure, Systolic/physiopathology , Heart Failure, Systolic/psychology , Prospective Studies , Sensitivity and Specificity , Severity of Illness IndexABSTRACT
BACKGROUND: Increased stiffening and decreased distensibility of the large arteries are associated with the presence of coronary artery disease and has been related to increased cardiovascular mortality in different populations. AIM: Aim of this present study was to investigate the elastic properties of the aortic wall in patients with slow coronary flow phenomenon. MATERIAL AND METHOD: We studied 20 patients with slow coronary flow phenomenon (age: 40+/-12 years)and 15 normal control subjects by echocardiography. Aortic strain (%) and distensibility (10(-3) mmHg(-1)) were calculated from the echocardiographically-derived thoracic Ao diameters (mm). The measurement of pulse pressure was obtained by cuff sphygmomanometry. RESULTS: There was no difference in the left ventricular ejection fraction, left ventricular end-diastolic and end-systolic diameters, left atrial diameters, left ventricular mass index between patients with slow coronary flow phenomenon and control groups. Maximal aortic diastolic diameter was increased in patients with slow coronary flow phenomenon compared with control group (p<0.05). Ao distensibility and Ao strain were lower in the patients with slow coronary flow phenomenon compared with control group (p<0.05). CONCLUSION: Reduced thoracic aortic elastic properties in patients with slow coronary flow phenomenon,assessed by echocardiography, apart from demonstrating subclinical atherosclerosis may also contribute to the etiopathogenesis of the slow coronary flow phenomenon necessitating more aggressive primary preventive measure.