Clinical and prognostic implications of self-rating depression scales and plasma B-type natriuretic peptide in hospitalized patients with chronic heart failure

John T Parissis ¹, Maria Nikolaou ¹, Dimitrios Farmakis ^1*, Vassiliki Bistola ¹, Ioannis A Paraskevaidis ¹, Stamatios Adamopoulos ¹, Gerasimos Filippatos ¹ and Dimitrios TH Kremastinos ¹

¹ Attikon University Hospital, Athens, Greece

^* To whom correspondence should be addressed. E-mail: dimitrios_farmakis{at}yahoo.com.

Accepted 7 August 2007

Abstract

Backgorund Depression is common among patients with chronic heart failure (CHF) and has been independently associated with a poorer prognosis.

Purpose This study evaluated the clinical and prognostic value of depression scales (Beck Depression Inventory-BDI, Zung Self-rating Depression Scale-Zung SDS) along with plasma B-type natriuretic peptide (BNP) in CHF.

Methods We studied 155 hospitalized CHF patients (ejection fraction 26.9iÀ6.4%) by depression (BDI, Zung SDS) and functional questionnaires (Kansas City Cardiomyopathy Questionnaire-KCCQ, Duke Activity Status Index-DASI), BNP and six-minute walk test (6MWT). Patients were followed for 6 months for cardiovascular events, including death of any reason or rehospitalization for CHF decompensation.

Results Seventy-six (49%) patients with depressive symptoms, as estimated by both scales, had significantly lower DASI and KCCQ scores (p<0.001), higher BNP (921iÀ889 vs 439iÀ267 pg/ml, p=0.001) and reduced 6MWT (p<0.001). According to logistic regression analysis, Zung SDS and BNP were independently associated with adverse clinical outcomes; values of Zung SDSi40 and of BNPi290 pg/ml predicted future events with a sensitivity of 82% and 94% and a specificity of 45% and 46%, respectively. The combination of Zung SDS plus BNP had an additive prognostic value, predicting events with a sensitivity of 77% and a specificity of 70% (event-free survival, Zung<40 and BNP<290 pg/ml 170iÀ9 days, Zungi40 and BNP<290 pg/ml 159iÀ14 days, Zung<40 and BNPi290 pg/ml 118iÀ15 days, Zungi40 and BNPi290 pg/ml 73iÀ8 days, p<0.0001).

Conclusions CHF patients with depressive symptoms have impaired physical activity, associated with excessive neurohormonal activation. Among the studied scales, Zung SDS seemed to independently predict clinical outcome, especially in patients with increased plasma BNP concentration. Hence, the combination of those two modalities provides a practical means for risk stratification in CHF.

Keywords: depression, exercise capacity, heart failure, nartiuretic peptides, neurohormonal activation

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