Women, but not men, have prolonged QT interval if depressed after an acute coronary syndrome

Center for Behavioral Cardiovascular Health, Columbia University Medical Center, New York, NY 10032, USA.
Europace (Impact Factor: 3.05). 07/2011; 14(2):267-71. DOI: 10.1093/europace/eur246
Source: PubMed

ABSTRACT Depression is a mortality risk marker for acute coronary syndrome (ACS) patients. We hypothesized that the QT interval, a predictor for risk of sudden cardiac death, was related to depressive symptoms in ACS.
We performed an analysis of admission electrocardiograms from hospitalized patients with unstable angina or non-ST elevation myocardial infarction from two prospective observational studies of depression in ACS. Depressive symptoms were assessed with the Beck Depression Inventory (BDI), and depression was defined as BDI score ≥10, compared with <5. Patients with QRS duration ≥120 ms and/or who were prescribed antidepressants were excluded. QT intervals were adjusted for heart rate by two methods. Our analyses included 243 men (40.0% with BDI ≥10) and 139 women (62.0% with BDI ≥ 10). Among women, average QT corrected by Fridericia's method (QTcF) was 435.4 ± 26.6 ms in the depressed group, vs. 408.6 ± 24.3 ms in the non-depressed group (P< 0.01). However, among men, average QTcF was not significantly different between the depressed and non-depressed groups (415.4 ± 23.6 vs. 412.0 ± 25.8 ms, P= 0.29). In multivariable analyses that included hypertension, diabetes, ACS type, left ventricular ejection fraction <0.40, and use of QT-prolonging medication, there was a statistically significant interaction between depressive symptoms and gender (P< 0.001).
In this ACS sample, prolongation of the QT interval was associated with depressive symptoms in women, but not in men. Further investigation of the mechanism of the relationship between depression and abnormal cardiac repolarization, particularly in women, is warranted to develop treatment strategies.


Available from: Karina W Davidson, Jun 08, 2015
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The presence of depression is reportedly related with cardiovascular diseases, including coronary artery disease (CAD), but little is known concerning the association between depressive symptoms reflecting the cultural constructions of female patients with chest pain as well as coronary artery stenosis, coronary vasospasm, and the corrected QT (QTc) interval. In a multicenter prospective cross-sectional survey of 163 Korean women with chest pain, the presence of depression was evaluated using the Beck Depression Inventory (BDI) and Lee and Rhee Depression (LRD) scales. The differences in the QTc interval and the presence of CAD (defined as ≥50% coronary artery stenosis on coronary angiography) and coronary vasospasm were compared between depressed and non-depressed women. Significant CAD was present in 83 of 163 female patients (mean age, 61years), and coronary vasospasm was present in 11 of 80 patients. The mean BDI and LRD scores were significantly higher in patients with significant CAD (BDI: 13.4±9.6 vs. 6.9±5.6, p<0.001; LRD: 46.9±21.4 vs. 39.8±15.2, p=0.027) and coronary vasospasm (BDI: 12.3±6.4 vs. 4.6±2.8; and LRD: 49.8±12.3 vs. 30.5±13.9; both p<0.05). On multivariate analysis, BDI scores were important risk factors for the presence of CAD (odds ratio [OR]=1.138; 95% confidence interval [CI]=1.071-1.210; p=0.021) and coronary vasospasm (OR=2.534; 95% CI=1.161-2.028; p=0.003), with similar findings obtained for LRD scores (CAD: OR=1.034; 95% CI=1.013-1.056; p=0.001; coronary vasospasm: OR=1.125; 95% CI=1.050-1.206; p=0.001). The mean QTc interval was also significantly higher in the depressed group than in the non-depressed group (440.1±32.0ms vs. 408.2±26.4ms; p<0.001). The QTc interval displayed significant positive with the BDI (r=0.595; p<0.001) and LRD scores (r=0.467; p<0.001). This study demonstrated that depression is associated with a prolonged QTc interval, CAD, and coronary vasospasm in female patients with chest pain, suggesting a possible mechanism by which depressive mood may be linked with coronary endothelial dysfunction and atherosclerosis. Copyright © 2015. Published by Elsevier Inc.
    Physiology & Behavior 02/2015; 143. DOI:10.1016/j.physbeh.2015.02.048 · 3.03 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: OBJECTIVE Several hundred studies have shown that depression is associated with an elevated risk of dying at follow-up. It is not clear, however, whether the mechanisms for this association are disease specific, leading to higher mortality in specific patient groups, or generic, resulting in comparable mortality rates in all patient groups as well as in community samples. The authors conducted a comprehensive meta-analysis of prospective studies of community as well as patient samples associating depression at baseline with excess mortality at follow-up. METHOD The authors conducted systematic searches of PubMed, PsycINFO, and Embase. Studies were included if depression was measured with a standardized instrument and mortality was reported for both depressed and nondepressed participants at follow-up. RESULTS A total of 293 studies including 1,813,733 participants (135,007 depressed and 1,678,726 nondepressed) from 35 countries were included. The overall unadjusted relative risk of mortality in depressed relative to nondepressed participants was 1.64 (95% CI=1.56-1.76), with high heterogeneity (I2=83, 95% CI=80-84). After adjustment for publication bias, the overall relative risk was reduced to 1.52 (95% CI=1.45-1.59). No strong indications were found that the pooled relative risk was different across the relatively healthy community samples and specific patient samples with heart disease, cancer, kidney disease, or other disease, except for a significantly higher risk in patients with chronic obstructive pulmonary disease (p<0.05). Also, the relative risk was lower when the follow-up period was longer and when the quality of the study was higher. CONCLUSIONS The authors could confirm the presence of a significant association between depression and excess mortality, although this association may have been overestimated because of publication bias and low study quality. Few indications were found that this association is stronger in community or specific patient samples.
    American Journal of Psychiatry 01/2014; 171(4). DOI:10.1176/appi.ajp.2013.13030325 · 13.56 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Depression is a recognized risk marker for mortality among acute coronary syndrome (ACS) patients. We hypothesized that ventricular arrhythmia detected by inpatient telemetry monitoring is more frequent among ACS patients with elevated depressive symptoms compared to those without depressive symptoms. We analysed data from patients enrolled in a prospective observational study of depression in ACS. Telemetry recordings during the index admission (average recording 21.3±3.0 hours) were analysed for frequent premature ventricular complexes (PVCs), defined as ≥10 per hour. The self-report Beck Depression Inventory (BDI) was used to assess depressive symptoms. Among 200 ACS patients, frequent PVCs were observed in 29% of patients with moderate depressive symptoms (BDI ≥10), 27% of those with mild symptoms (BDI 5-9), and only 11% of those with no/minimal symptoms (p=0.02). Log-transformed PVCs per hour were associated with depressive symptom category (p=0.008). In a multivariable logistic regression model that included age, gender, left ventricular ejection fraction, cardiovascular risk score, heart rate, and QT interval, mild symptoms (OR 3.02, 95% 0.97-9.43, p=0.058) and moderate-severe symptoms (OR 3.94, 95% CI 1.27-12.22, p=0.018) were associated with frequent PVCs. In this sample of ACS patients, depressive symptoms were independently associated with frequent PVCs during inpatient telemetry monitoring.
    03/2013; 2(1):61-7. DOI:10.1177/2048872613476101