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Depression and anxiety as predictors of heart rate variability after myocardial infarction

Published online by Cambridge University Press:  08 November 2007

E. J. Martens ,
I. Nyklíček ,
B. M. Szabó  and
N. Kupper
E. J. Martens*
Affiliation:
CoRPS – Centre of Research on Psychology in Somatic Diseases, Tilburg University, The Netherlands
I. Nyklíček
Affiliation:
CoRPS – Centre of Research on Psychology in Somatic Diseases, Tilburg University, The Netherlands
B. M. Szabó
Affiliation:
Department of Cardiology, St Elisabeth Hospital Tilburg, The Netherlands
N. Kupper
Affiliation:
CoRPS – Centre of Research on Psychology in Somatic Diseases, Tilburg University, The Netherlands
*
*Address for correspondence: E. J. Martens, Ph.D., CoRPS, Tilburg University, PO Box 90153, 5000 LE Tilburg, The Netherlands. (Email: E.J.Martens@uvt.nl)
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Abstract

Background

Reduced heart rate variability (HRV) is a prognostic factor for cardiac mortality. Both depression and anxiety have been associated with increased risk for mortality in cardiac patients. Low HRV may act as an intermediary in this association. The present study examined to what extent depression and anxiety differently predict 24-h HRV indices recorded post-myocardial infarction (MI).

Method

Ninety-three patients were recruited during hospitalization for MI and assessed on self-reported symptoms of depression and anxiety. Two months post-MI, patients were assessed on clinical diagnoses of lifetime depressive and anxiety disorder. Adequate 24-h ambulatory electrocardiography data were obtained from 82 patients on average 78 days post-MI.

Results

In unadjusted analyses, lifetime diagnoses of major depressive disorder was predictive of lower SDNN [standard deviation of all normal-to-normal (NN) intervals; β=−0.26, p=0.022] and SDANN (standard deviation of all 5-min mean NN intervals; β=0.25, p=0.023), and lifetime anxiety disorder of lower RMSSD (root mean square of successive differences; β=−0.23, p=0.039). Depression and anxiety symptoms did not significantly predict HRV. After adjustment for age, sex, cardiac history and multi-vessel disease, lifetime depressive disorder was no longer predictive of HRV. Lifetime anxiety disorder predicted reduced high-frequency spectral power (β=−0.22, p=0.039) and RMSSD (β=−0.25, p=0.019), even after additional adjustment of anxiety symptoms.

Conclusions

Clinical anxiety, but not depression, negatively influenced parasympathetic modulation of heart rate in post-MI patients. These findings elucidate the physiological mechanisms underlying anxiety as a risk factor for adverse outcomes, but also raise questions about the potential role of HRV as an intermediary between depression and post-MI prognosis.

Keywords

Anxietydepressionheart rate variabilitymyocardial infarction
Type
Original Articles
Information
Psychological Medicine , Volume 38 , Issue 3 , March 2008 , pp. 375 - 383
Copyright
Copyright © Cambridge University Press 2007

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References

APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychiatric Association: Washington, DC.Google Scholar
Barefoot, JC, Helms, MJ, Mark, DB (1996). Depression and long-term mortality risk in patients with coronary artery disease. American Journal of Cardiology 78, 613–617.CrossRefGoogle ScholarPubMed
Beck, AT, Steer, RA (1993). Manual for the Revised Beck Depression Inventory. Psychological Corporation: San Antonio, TX.Google Scholar
Beck, AT, Steer, RA, Garbin, MC (1988). Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation. Clinical Psychology Review 8, 77–100.Google Scholar
Bigger, JT, Fleiss, JL, Rolnitzky, LM, Steinman, RC (1993). The ability of several short-term measures of RR variability to predict mortality after myocardial infarction. Circulation 88, 927–934.Google Scholar
Birkhofer, A, Schmidt, G, Förstl, H (2006). Heart rate variability and depression. Archives of General Psychiatry 63, 1052.CrossRefGoogle ScholarPubMed
Carney, RM, Blumenthal, JA, Freedland, KE, Stein, PK, Howells, WB, Berkman, LF, Watkins, LL, Czajkowski, SM, Hayano, J, Domitrovich, PP, Jaffe, AS (2005). Low heart rate variability and the effect of depression on post-myocardial infarction mortality. Archives of Internal Medicine 165, 1486–1491.Google Scholar
Carney, RM, Blumenthal, JA, Stein, PK, Watkins, L, Catellier, D, Berkman, LF, Czajkowski, SM, O'Connor, C, Stone, PH, Freedland, KE (2001). Depression, heart rate variability, and acute myocardial infarction. Circulation 104, 2024–2028.CrossRefGoogle ScholarPubMed
Carney, RM, Freedland, KE, Stein, PK, Watkins, LL, Catellier, D, Jaffe, AS, Yeragani, VK (2003). Effects of depression on QT interval variability after myocardial infarction. Psychosomatic Medicine 65, 177–180.Google Scholar
Carney, RM, Saunders, RD, Freedland, KE, Stein, P, Rich, MW, Jaffe, AS (1995). Association of depression with reduced heart rate variability in coronary artery disease. American Journal of Cardiology 76, 562–564.CrossRefGoogle ScholarPubMed
Carpeggiani, C, Emdin, M, Bonaguidi, F, Landi, P, Michelassi, C, Trivella, MG, Macerata, A, L'Abbate, A (2005). Personality traits and heart rate variability predict long-term cardiac mortality after myocardial infarction. European Heart Journal 26, 1612–1617.Google Scholar
Cohen, H, Benjamin, J (2006). Power spectrum analysis and cardiovascular morbidity in anxiety disorders. Autonomic Neuroscience 128, 1–8.CrossRefGoogle ScholarPubMed
Dekker, JM, Crow, RS, Folsom, AR, Hannan, PJ, Liao, D, Swenne, CA, Schouten, EG (2000). Low heart rate variability in a 2-minute rhythm strip predicts risk of coronary heart disease and mortality from several causes: the ARIC Study. Atherosclerosis Risk In Communities. Circulation 102, 1239–1244.Google Scholar
Drago, S, Bergerone, S, Anselmino, M, Varalda, PG, Cascio, B, Palumbo, L, Angelini, G, Trevi, PG (2007). Depression in patients with acute myocardial infarction: influence on autonomic nervous system and prognostic role. Results of a five-year follow-up study. International Journal of Cardiology 31, 46–51.Google Scholar
Frasure-Smith, N, Lespérance, F, Juneau, M, Talajic, M, Bourassa, MG (1999). Gender, depression, and one-year prognosis after myocardial infarction. Psychosomatic Medicine 61, 26–37.CrossRefGoogle ScholarPubMed
Frasure-Smith, N, Lespérance, F, Talajic, M (1995 a). Depression following myocardial prognosis after myocardial infarction. Circulation 91, 999–1005.CrossRefGoogle ScholarPubMed
Frasure-Smith, N, Lespérance, F, Talajic, M (1995 b). The impact of negative emotions on prognosis following myocardial infarction: is it more than depression? Health Psychology 14, 388–398.CrossRefGoogle ScholarPubMed
Gehi, A, Mangano, D, Pipkin, S, Browner, WS, Whooley, MA (2005). Depression and heart rate variability in patients with stable coronary heart disease: findings from the Heart and Soul Study. Archives of General Psychiatry 62, 661–666.CrossRefGoogle ScholarPubMed
Gehi, A, Whooley, M (2006). Heart rate variability and depression – reply. Archives of General Psychiatry 63, 1052.CrossRefGoogle Scholar
Gorman, JM, Sloan, RP (2000). Heart rate variability in depressive and anxiety disorders. American Heart Journal 140, 77–83.Google Scholar
Hallas, CN, Thornton, EW, Fabri, BM, Fox, MA, Jackson, M (2003). Predicting blood pressure reactivity and heart rate variability from mood state following coronary artery bypass surgery. International Journal of Psychophysiology 47, 43–55.CrossRefGoogle ScholarPubMed
Huikuri, HV, Tapanainen, JM, Lindgren, K, Raatikainen, P, Makikallio, TH, Juhani Airaksinen, KE, Myerburg, RJ (2003). Prediction of sudden cardiac death after myocardial infarction in the beta-blocking era. Journal of the American College of Cardiology 42, 652–658.Google Scholar
Klein, E, Cnaani, E, Harel, T, Braun, S, Ben-Haim, SA (1995). Altered heart rate variability in panic disorder patients. Biological Psychiatry 37, 18–24.Google Scholar
Knight, RG, Waal-Manning, HJ, Spears, GF (1983). Some norms and reliability data for the State-Trait Anxiety Inventory and the Zung Self-Rating Depression Scale. British Journal of Clinical Psychology 22, 245–249.CrossRefGoogle ScholarPubMed
Ladwig, KH, Roll, G, Breithardt, G (1994). Post-infarction depression and incomplete recovery 6 months after acute myocardial infarction. Lancet 343, 20–23.Google Scholar
Lane, D, Carroll, D, Ring, C, Beevers, DG, Lip, GY (2001). Mortality and quality of life 12 months after myocardial infarction: effects of depression and anxiety. Psychosomatic Medicine 63, 221–230.CrossRefGoogle ScholarPubMed
Lavoie, KL, Fleet, RP, Laurin, C, Arsenault, A, Miller, SB, Bacon, SL (2004). Heart rate variability in coronary artery disease patients with and without panic disorder. Psychiatry Research 128, 289–299.CrossRefGoogle ScholarPubMed
Lespérance, F, Frasure-Smith, N, Talajic, M, Bourassa, MG (2002). Five-year risk of cardiac mortality in relation to initial severity and one-year changes in depression symptoms after myocardial infarction. Circulation 105, 1049–1053.Google Scholar
Malik, J, Bigger, JT, Camm, J, Kleiger, RE, Malliani, A, Moss, AJ, Schwartz, PJ; Task Force Writing Committee (1996). Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation 93, 1043–1065.Google Scholar
Mayou, RA, Gill, D, Thompson, DR, Day, A, Hicks, N, Volmink, J, Neil, A (2000). Depression and anxiety as predictors of outcome after myocardial infarction. Psychosomatic Medicine 62, 212–219.Google Scholar
McCaffery, JM, Frasure-Smith, N, Dube, MP, Theroux, P, Rouleau, GA, Duan, Q, Lesperance, F (2006). Common genetic vulnerability to depressive symptoms and coronary artery disease: a review and development of candidate genes related to inflammation and serotonin. Psychosomatic Medicine 68, 187–200.Google Scholar
Middeldorp, CM, Cath, DC, Van Dyck, R, Boomsma, DI (2005). The co-morbidity of anxiety and depression in the perspective of genetic epidemiology. A review of twin and family studies. Psychological Medicine 35, 611–624.CrossRefGoogle ScholarPubMed
Moser, DK, Dracup, K (1996). Is anxiety early after myocardial infarction associated with subsequent ischemic and arrhythmic events? Psychosomatic Medicine 58, 395–401.CrossRefGoogle ScholarPubMed
Pitzalis, MV, Iacoviello, M, Todarello, O, Fioretti, A, Guida, P, Massari, F, Mastropasqua, F, Russo, GD, Rizzon, P (2001). Depression but not anxiety influences the autonomic control of heart rate after myocardial infarction. American Heart Journal 141, 765–771.Google Scholar
Podrid, PJ, Fuchs, T, Candinas, R (1990). Role of the sympathetic nervous system in the genesis of ventricular arrhythmia. Circulation 82, 103–113.Google Scholar
Pruvot, E, Thonet, G, Vesin, JM, van-Melle, G, Seidl, K, Schmidinger, H, Brachmann, J, Jung, W, Hoffmann, E, Tavernier, R, Block, M, Podczeck, A, Fromer, M (2000). Heart rate dynamics at the onset of ventricular tachyarrhythmias as retrieved from implantable cardioverter-defibrillators in patients with coronary artery disease. Circulation 101, 2398–2404.Google Scholar
Scherrer, JF, Xian, H, Bucholz, KK, Eisen, SA, Lyons, MJ, Goldberg, J, Tsuang, M, True, WR (2003). A twin study of depression symptoms, hypertension, and heart disease in middle-aged men. Psychosomatic Medicine 65, 548–557.CrossRefGoogle ScholarPubMed
Sloan, RP, Bigger, JT Jr. (1991). Biobehavioral factors in Cardiac Arrhythmia Pilot Study (CAPS). Review and examination. Circulation 83, II52–II57.Google ScholarPubMed
Smeets, R, Dingemans, P (1993). Composite International Diagnostic Interview (CIDI), Version 1.1. University of Amsterdam: Amsterdam, The Netherlands.Google Scholar
Spielberger, CD, Gorsuch, RL, Lushene, R, Vagg, PR, Jacobs, GA (1983). Manual for the State-Trait Anxiety Inventory (Form Y). Consulting Psychologists Press: Palo Alto, CA.Google Scholar
Stein, PK, Carney, RM, Freedland, KE, Skala, JA, Jaffe, AS, Kleiger, RE, Rottman, JN (2000 a). Severe depression is associated with markedly reduced heart rate variability in patients with stable coronary heart disease. Journal of Psychosomatic Research 48, 493–500.CrossRefGoogle ScholarPubMed
Stein, PK, Domitrovich, PP, Huikuri, HV, Kleiger, RE (2005). Traditional and nonlinear heart rate variability are each independently associated with mortality after myocardial infarction. Journal of Cardiovascular Electrophysiology 16, 13–20.Google Scholar
Stein, PK, Domitrovich, PP, Kleiger, RE, Schechtman, KB, Rottman, JM (2000 b). Clinical and demographic determinants of heart rate variability in patients post myocardial infarction: insights from the Cardiac Arrhythmia Suppression Trial (CAST). Clinical Cardiology 23, 187–194.CrossRefGoogle ScholarPubMed
Strik, JJ, Denollet, J, Lousberg, R, Honig, A (2003). Comparing symptoms of depression and anxiety as predictors of cardiac events and increased health care consumption after myocardial infarction. Journal of the American College of Cardiology 42, 1801–1807.CrossRefGoogle ScholarPubMed
Thayer, JF, Wang, X, Snieder, H (2006). Ethnic differences in heart rate variability: does ultra-low frequency heart rate variability really measure autonomic tone? American Heart Journal 152, e27.Google Scholar
Vigo, DE, Nicola Siri, L, Ladron De Guevara, MS, Martinez-Martinez, JA, Fahrer, RD, Cardinali, DP, Masoli, O, Guinjoan, SM (2004). Relation of depression to heart rate nonlinear dynamics in patients ⩾60 years of age with recent unstable angina pectoris or acute myocardial infarction. American Journal of Cardiology 93, 756–760.Google Scholar
Watkins, LL, Blumenthal, JA, Carney, RM (2002). Association of anxiety with reduced baroreflex cardiac control in patients after acute myocardial infarction. American Heart Journal 143, 460–466.CrossRefGoogle ScholarPubMed
Watkins, LL, Grossman, P, Krishnan, R, Blumenthal, JA (1999). Anxiety reduces baroreflex cardiac control in older adults with major depression. Psychosomatic Medicine 61, 334–340.Google Scholar
WHO (1990). Composite International Diagnostic Interview (CIDI). World Health Organization: Geneva, Switzerland.Google Scholar
Wittchen, HU (1994). Reliability and validity studies of the WHO-Composite International Diagnostic Interview (CIDI). Journal of Psychiatric Research 28, 57–84.Google Scholar
Wittchen, HU, Robins, LN, Cotter, LB, Sartorius, N, Burke, JD, Regier, D (1991). Cross-cultural feasibility, reliability and sources of variance of the Composite International Diagnostic Interview (CIDI): the Multicentre WHO/ADAMHA Field Trials. British Journal of Psychiatry 159, 645–653.Google Scholar
Yeragani, VK, Pohl, R, Berger, R, Balon, R, Ramesh, C, Glitz, D, Srinivasan, K, Weinberg, P (1993). Decreased heart rate variability in panic disorder patients: a study of power-spectral analysis of heart rate. Psychiatry Research 46, 89–103.CrossRefGoogle ScholarPubMed
Zuanetti, G, Neilson, JM, Latini, R, Santoro, E, Maggioni, AP, Ewing, DJ (1996). Prognostic significance of heart rate variability in post-myocardial infarction patients in the fibrinolytic era. The GISSI-2 results. Gruppo Italiano per lo Studio della Sopravvivenza nell' Infarto Miocardico. Circulation 94, 432–436.Google Scholar