Abstract 1532: Combined Prognostic Value Of Self-rating Depression Scores And Plasma B-type Natriuretic Peptide In Hospitalized Patients With Chronic Heart Failure
Depression is associated with high mortality and morbidity in chronic heart failure (CHF). We assessed the value of two widely used depression scores (Beck Depression Inventory-BDI, Zung Self-rating Depression Scale-Zung SDS) along with plasma B type natriuretic peptide (BNP) in predicting adverse outcomes in CHF patients.
Methods: 155 CHF patients (aged 65±12 years, mean NYHA 2.5±0.7, mean ejection fraction 27±6%) were studied. Six-minute walk test (6MWT) was also performed. Patients were subsequently followed for 6 months for major cardiovascular events defined as death or hospitalization due to cardiovascular causes.
Results: Seventy-six of 155 (49%) patients had a Zung SDS>40 and a BDI>10 and were characterized as having depressive symptoms. These patients had significantly higher levels of BNP (921±889 vs 439±267 pg/ml, p=0.001) and reduced exercise capacity (6MWT 238±121 vs 356±107 m, p<0.001). Significant correlations were observed between Zung SDS and BNP (p<0.05). Logistic regression analysis, including LVEF, NYHA, scores, BNP and 6MWT as independent variables, revealed that only Zung SDS (p<0.05) and BNP (p<0.05) were independently associated with clinical outcome. According to Receiver Operating Characteristic (ROC) analysis, Zung SDS>40 (AUC=0.683, p<0.001) and BNP>−290 ng/ml (AUC=0.695, p<0.001) may predict future events with a sensitivity of 82% and 94% and a specificity of 45% and 46%, respectively. Patients scoring Zung SDS>40 had a shorter event-free survival (188±14 days vs 125±12 days, log rank test p<0.001). Patients with BNP>−290 pg/ml also had a shorter event free survival. The combination of Zung SDS and BNP appears to have an additive prognostic value, predicting adverse clinical outcome with a sensitivity of 77% and a specificity of 70% (mean event-free survival, Zung<40 and BNP<290 pg/ml 170 ± 9 days, Zung>40 and BNP<290 pg/ml 159 ± 14 days, Zung<40 and BNP>−290 pg/ml 118 ± 15 days, Zung>40 and BNP>−290 pg/ml 73 ± 8 days, log rank test p<0.0001).
Conclusion: Depressive symptoms are associated with excessive neurohormonal activation in CHF. Among the studied scales, only Zung SDS seemed to independently predict clinical outcome. The addition of BNP to Zung SDS defines a subgroup of CHF patients at a higher risk for future events.