Cardiac-related hospitalization and/or death associated with immune dysregulation and symptoms of depression in heart failure patients.

Full Abstract

OBJECTIVE:
Congestive heart failure (CHF) patients with depressive symptoms have a greater risk of morbidity and mortality. Immune activity such as inflammation is increasingly implicated as underlying this relationship. However, it is unknown whether there is a broader spectrum of immune dysregulation beyond inflammatory activity. This study examined in CHF patients the relationship of depressive symptoms with cellular immune activity measured by Th1/Th2 ratios and cardiac rehospitalization and/or death.

METHOD:
Eighteen patients with CHF (mean age = 62, NYHA classes II-IV) were enrolled and depressive symptoms were measured with interviewer ratings using the Hamilton Rating Scale-Depression. For the determination of Th1/Th2 ratios, intracellular cytokine expression of interferon-gamma (IFN-gamma) and interleukin-10 (IL-10) CD4+ T cells were measured by flow cytometry. Plasma interleukin-6 levels were measured to ascertain circulating inflammatory cytokine activity. Patient records were examined for cardiac related rehospitalization or cardiac related death over a two-year period after baseline depression and immune measures were taken.

RESULTS:
Higher depression scores were associated with a prospective increase in incidence of cardiac related hospitalizations and/or death (p = .037). Lesser IFN-gamma/IL-10 expressing CD4+ T cell ratios were related to higher depressive symptom scores at baseline (p = .005) and a prospective increased incidence of cardiac related hospitalization or death over a two-year period (p = .05).

CONCLUSIONS:
A shift in the Th1/Th2 ratio may play a role in the association between depressive symptoms and morbidity and mortality in CHF patients, suggesting broader immune dysregulation than previously considered.

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Author information

Author/s: Redwine, Laura S (LS); Mills, Paul J (PJ); Hong, Suzi (S); Rutledge, Thomas (T); Reis, Veronica (V); Maisel, Alan (A); Irwin, Michael R (MR);

Affiliation: Department of Medicine, University of California, San Diego, CA, USA. lredwine(-atsign-)vapop.ucsd.edu

Journal and publication information

Publication Type: Journal Article; Research Support, Non-U.S. Gov't

Journal: Psychosomatic medicine (Psychosom Med), published in United States. (Language: eng)

Reference: 2007-Jan; vol 69 (issue 1) : pp 23-9

Dates: Created 2007/01/24; Completed 2007/02/22; Revised 2007/11/15;

PMID: 17244845, status: MEDLINE (last retrieval date: 12/26/2008)

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Aged
Cytokines - blood
Depression - immunology
Follow-Up Studies
Heart Failure - immunology; mortality; psychology
Humans
Immunity, Cellular

Associated Chemicals: Cytokines (0)

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