Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Jan 19, 2024; 14(1): 53-62
Published online Jan 19, 2024. doi: 10.5498/wjp.v14.i1.53
Assessing myocardial indices and inflammatory factors to determine anxiety and depression severity in patients with chronic heart failure
Li Zhang, Qiang Wang, Hong-Sheng Cui, Yuan-Yuan Luo
Li Zhang, Qiang Wang, Hong-Sheng Cui, Department of Cardiology, Jingzhou Hospital, Yangtze University, Jingzhou 434020, Hubei Province, China
Yuan-Yuan Luo, Department of Intensive Care Unit, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510000, Guangdong Province, China
Co-first authors: Li Zhang and Qiang Wang.
Author contributions: Zhang L and Wang Q contributed equally to this work as first co-authors. Zhang L and Wang Q conceived, designed, and refined the study protocol; Cui HS was involved in data collection and analysis; Luo YY guided and supervised the research; and all authors were involved in the critical review of the results and have contributed to, read, and approved the final manuscript.
Institutional review board statement: The study was reviewed and approved by the Jingzhou Hospital, Yangtze University Institutional Review Board (2023-053-01).
Informed consent statement: The requirement for informed consent was waived given the retrospective nature of the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The clinical data used in this study can be obtained from the corresponding author upon request.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yuan-Yuan Luo, MM, Associate Chief Physician, Department of Intensive Care Unit, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 16 Airport Road, Guangzhou 510000, Guangdong Province, China. kellyyuan1983@163.com
Received: November 6, 2023
Peer-review started: November 6, 2023
First decision: November 16, 2023
Revised: November 25, 2023
Accepted: December 21, 2023
Article in press: December 21, 2023
Published online: January 19, 2024
Abstract
BACKGROUND

Patients with chronic heart failure (CHF) have a progressive disease that is associated with poor quality of life and high mortality. Many patients experience anxiety and depression (A&D) symptoms, which can further accelerate disease progression. We hypothesized that indicators of myocardial function and inflammatory stress may reflect the severity of A&D symptoms in patients with CHF. Changes in these biomarkers could potentially predict whether A&D symptoms will deteriorate further in these individuals.

AIM

To measure changes in cardiac and inflammatory markers in patients with CHF to determine A&D severity and predict outcomes.

METHODS

We retrospectively analyzed 233 patients with CHF treated at the Jingzhou Hospital, Yangtze University between 2018-2022 and grouped them according to Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS) scores. We compared clinical data in the no-A&D, mild-A&D, moderate-A&D, and severe-A&D groups, the SAS and SDS scores with the New York Heart Association (NYHA) functional classification, and cardiac markers and inflammatory factors between the no/mild-A&D and moderate/severe-A&D groups. Regression analysis was performed on the markers with P < 0.05 to determine their ability to predict A&D severity in patients and the area under the receiver operating characteristic curve (AUROC) was used to evaluate their accuracy.

RESULTS

In the inter-group comparison, the following variables had an effect on A&D severity in patients with CHF: NYHA class, left ventricular ejection fraction (LVEF), left ventricular end-diastolic diameter, N-terminal pro-brain natriuretic peptide (NT-proBNP), interleukin-6 (IL-6), and tumor necrosis factor-alpha (P < 0.05). Other variables did not differ significantly between the A&D groups (P > 0.05). In addition, we found that higher NYHA classes were associated with higher the SAS and SDS scores (P < 0.05). Regression analysis showed that LVEF, NT-proBNP, and IL-6 were independent risk factors for A&D severity (P < 0.05). Among them, NT-proBNP had the best predictive ability as a single indicator (AUROC = 0.781). Furthermore, the combination of these three indicators exhibited a good predictive effect toward discriminating the extent of A&D severity among patients (AUROC = 0.875).

CONCLUSION

Cardiac and inflammatory biomarkers, such as LVEF, NT-proBNP, and IL-6, are correlated with A&D severity in patients with CHF and have predictive value.

Keywords: Chronic heart failure, Anxiety, Depression, Cardiac markers, Inflammatory factors, Prediction

Core Tip: We investigated patients with chronic heart failure (CHF) with varying degrees of anxiety and depression (A&D) symptoms and assessed changes in myocardial markers and inflammatory factors to determine their associations with A&D severity. We used independent risk factors as predictive indicators and assessed their discriminative accuracy in predicting A&D severity using the area under the receiver operating characteristic curve. We demonstrated that A&D symptoms can affect the progression of CHF and lead to worse outcomes for patients.