Abstract 12924: Unstable Angina Patients with Depression Have Left Ventricular Hypertrophy by Electrocardiogram: A Replication in Two Studies
Introduction: Depression is a recognized risk marker for mortality among acute coronary syndrome (ACS) patients, possibly due to sudden cardiac death (SCD). Elevated sympathetic tone and reduced heart rate variability have also been recognized in depression. We hypothesized that markers of SCD risk by 12-lead ECG might be present in ACS patients with depressive symptoms, and evaluated this question in unstable angina (UA) patients in order to minimize ST-T wave changes associated with the coronary event.
Methods: We analyzed admission ECGs from 145 patients hospitalized for UA and who were enrolled in a prospective multicenter observational study of depression in ACS. Assessment of depressive symptoms during admission was performed with the self-report Beck Depression Inventory (BDI), and depression was defined as score ≥10. ECG comparisons were performed between the depressed and non-depressed patients who were in sinus/non-paced rhythm. A group of 111 patients from a second prospective study of hospitalized UA patients, with similar assessment of depressive symptoms, was then analyzed. Multivariable logistic regression analyses adjusted for variables including left ventricular ejection fraction, QRS duration, presence of Q waves, and ST depression.
Results: In the initial group (73 depressed patients, 72 non-depressed) left ventricular hypertrophy (LVH) by either Sokolow-Lyon index and/or Cornell voltage criteria was found to be more frequent in the depressed group (19.2% v 5.6%, multivariable HR 4.42, 95% CI 1.25–15.6, p=0.02). In the second group of 111 UA patients (42 depressed, 69 non-depressed), LVH was again more frequent in the depressed group (23.8% v 7.7%, multivariable HR 3.98, 95% CI 1.22–13.0, p=0.02). Other measures were similar between the depressed and non-depressed groups, including average heart rate, PR interval, QRS duration, corrected QT interval, and presence of T wave inversions.
Conclusions: In two separate groups of UA patients, depressive symptoms were reproducibly associated with increased LVH by ECG, a known prognostic marker for mortality and SCD in unselected cardiac patients. Interventions to address the poor survival prognosis associated with depression in ACS patients may need to focus on SCD risk.
- © 2010 by American Heart Association, Inc.