Depression and all-cause mortality in patients with congestive heart failure and an implanted cardiac device.

OBJECTIVE: The purpose of this study was to assess the association between depression and all-cause mortality in patients with congestive heart failure (CHF) and an implanted cardiac device. METHODS: The study enrolled 260 patients (mean age 56.8±10.0 years; 83.1% male) with CHF and an implanted cardiac device (156 patients with a resynchronization therapy cardiac device, 104 patients with an implantable cardioverter defibrillator). The mean duration of follow-up was 48.6±32.2 months. The Beck Depression Inventory was used to measure depressive symptoms. Depression was considered absent for a score between 0 and 9, mild to moderate for a score between 10 and 18, and severe if the score was 19 or greater. The Cox proportional hazards regression model was used to estimate hazard ratios (HR) with a 95% confidence interval (CI) for the impact of depression on all-cause mortality. The HR was calculated after adjustment for the following confounders: age, gender, smoking status, hypertension, diabetes mellitus, body mass index, hypercholesterolemia, left ventricular ejection fraction, number of hemodynamically significant lesions of the coronary arteries, and the type of implanted cardiac device. RESULTS: During the follow-up period, 37 patients died (14.2%). The adjusted HR of depression for all-cause mortality was 1.05, with a 95% CI of 1.01-1.09. Patients without depression were accepted as a reference group with HR=1.0 for analysis of the categorical indicator. The HR was 1.32, with a 95% CI of 0.57-3.03, in patients with mild depressive symptoms, and the HR was 3.18 with a 95% CI of 1.31-7.73 in patients with severe depressive symptoms. CONCLUSION: Increased depressive symptoms were independently associated with all-cause mortality in patients with CHF and an implanted cardiac device.

Gender in cardiac resynchronisation therapy.

Introduction: Gender differences in cardiac resynchronisation therapy (CRT) response are not clear enough. This study aimed to assess gender influence on systemic inflammation, neurohormonal activation, fibrosis in patients with congestive heart failure (CHF) and CRT. Methods: We compared group I (61 men) and group II (16 women) of patients undergoing CRT. Plasma levels of Nt-proBNP, interleukin (IL)-1ß, IL-6, IL-10, tumor necrosis factor alpha (TNF-α), C-reactive protein, galectin-3 (Gal-3), metalloproteinase-9 (MMP-9), tissue inhibitors of metalloproteinase 1 and 4 (TIMP-1, TIMP-4), ratio MMP-9/TIMP-1, MMP-9/TIMP-4 were measured. According to dynamics of left ventricular end-systolic volume patients were classified into non-responders, responders, super-responders. Results: Women more likely had left bundle branch block (81.3 vs 47.5%, P = 0.016), were more super-responders (66.7 vs 30.5%). Both groups showed decrease of IL-6 (P < 0.05), TNF-α (P < 0.001; P < 0.05), NT-proBNP (P = 0.001; P < 0.05), Gal-3 (P < 0.05). In women there was decrease of IL-6 by 44.4 vs 23.5% in men (PP = 0.029), TNF-α by 41.4 vs 30.9%, NT-proBNP by 73.3 vs 46% (P = 0.002), Gal-3 by 82.3 vs 64.9% (P < 0.05). Group I also showed decrease of IL-10 by 34.2% (P < 0.05). Group dynamics of TIMP-1 was opposite: men showed tendency to reduction of TIMP-1 (P = 0.054), women showed increase of TIMP-1 (P < 0.05). Besides, men showed decrease of MMP-9 (P < 0.05) and ratio MMP-9/TIMP-4 (P < 0.05). Conclusion: The best response to CRT is associated with female gender explained by greater decrease of neurohormonal activation, systemic inflammation and fibrosis. The revealed opposite dynamics of TIMP-1 in the groups can demonstrate the existence of gender features of matrix metalloproteinase system activity and their tissue inhibitors.