The Relationship among Depressive Symptoms, N-Terminal pro B Type Natriuretic Peptide, and Cardiac Events in Patients with Heart Failure

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Background: Depressive symptoms and N-terminal pro B-type natriuretic peptide (NT-pro BNP) predict cardiac events in heart failure (HF). However, the relationship among depressive symptoms, NT-pro BNP, and cardiac events in HF is unknown. Purpose. To determine whether depressive symptoms influence the relationship of NT-pro BNP to cardiac event-free survival in HF patients. Methods: A total of 149 patients with HF (75% male, 61±11 years, 55% New York Heart Association [NYHA] class III/IV, ejection fraction [EF] 31±12%) were recruited from outpatient HF clinics. Depressive symptoms were measured by the Patient Health Questionnaire 9 (PHQ-9). Blood was drawn to measure NT-pro BNP and patients divided into groups by median split at 558pg/ml. Cardiac event-free survival (emergency department visits, hospitalization, and cardiac death) was collected for a mean of 406 follow-up days and confirmed by hospital record review. Cox proportional hazards regression was used to identify the relationship of NT-pro BNP and depressive symptoms to cardiac event. The Kaplan-Meier curve with log rank test was used to determine whether the association of NT-pro BNP to cardiac event-free survival differed by depressive symptoms. Results: In Cox regression, severe depressive symptoms (hazard ratio [HR]=1.074, 95% confidence interval [CI]=1.004–1.149) and increased NT-pro BNP (HR=1.001, 95% CI=1.000–1.001) independently predicted cardiac event-free survival after controlling for age, sex, body mass index, HF etiology, NYHA class, comorbidities, and EF. Patients with depressive symptoms (PHQ-9>10) and high NT-pro BNP (>558pg/ml) had shorter cardiac event-free survival (p=.009). In a separate model, the interaction for depressive symptoms by NT-pro BNP predicted shorter cardiac event-free survival. (p=.003).

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Conclusions: The relationship of NT-pro BNP to cardiac event-free survival was altered by depressive symptoms in HF patients. High levels of depressive symptoms may exacerbate HF, reflected by increased NT-pro BNP, resulting in worse cardiac event-free survival.