Association of Depression and Anxiety with Cardiac Structural and Functional Characteristics in Heart Failure with Reduced and Mildly Reduced Ejection Fraction

Timea Magdolna Szabo; Előd Ernő Nagy; Ádám Kirchmaier; Erhard Heidenhoffer; Hunor-László Gábor-Kelemen; Marius Frăsineanu; Attila Frigy

doi:10.3390/clinpract13020036

Association of Depression and Anxiety with Cardiac Structural and Functional Characteristics in Heart Failure with Reduced and Mildly Reduced Ejection Fraction

Clin Pract. 2023 Mar 9;13(2):398-409. doi: 10.3390/clinpract13020036.

Authors

Timea Magdolna Szabo¹, Előd Ernő Nagy^{1

2}, Ádám Kirchmaier³, Erhard Heidenhoffer³, Hunor-László Gábor-Kelemen³, Marius Frăsineanu³, Attila Frigy^{3

4}

Affiliations

¹ Department of Biochemistry and Environmental Chemistry, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540142 Târgu Mureș, Romania.
² Laboratory of Medical Analysis, Clinical County Hospital Mureș, 540394 Târgu Mureș, Romania.
³ Department of Cardiology, Clinical County Hospital Mureș, 540103 Târgu Mureș, Romania.
⁴ Department of Internal Medicine IV, George Emil Palade University of Medicine, Pharmacy, Science and Technology of Târgu Mureș, 540103 Târgu Mureș, Romania.

Abstract

Heart failure and mental health conditions frequently coexist and have a negative impact on health-related quality of life and prognosis. We aimed to evaluate depression and anxiety symptoms and to determine the association between psychological distress and cardiac parameters in heart failure with reduced and mildly reduced ejection fraction. A total of 43 patients (33 male, mean age 64 ± 10 years) with heart failure and left ventricular systolic dysfunction (29 with HFrEF, 14 with HFmrEF) underwent comprehensive echocardiographic evaluation. All study participants completed questionnaires for the assessment of depression (PHQ-9), anxiety (GAD-7), and health-related quality of life (MLHFQ). Ten (34%) patients with HFrEF and two (14%) participants with HFmrEF had moderate-to-severe depression symptoms. Significant anxiety symptoms were more frequent in HFrEF (10 vs. 2 patients; 34% vs. 14%). Poor quality of life was also more common among patients with HFrEF (17 vs. 5 patients; 59% vs. 36%), showing higher MLHFQ scores (p = 0.009). Moreover, PHQ-9, GAD-7, and MLHFQ scores showed significant correlations between NYHA class severity and the presence of peripheral edema. The symptoms of dyspnea correlated with both PHQ-9 and MLHFQ scores. Significant correlations were observed between MLHFQ scores and a large number of clinical features, such as exercise capacity, 6MWT distance, the need for furosemide, echocardiographic parameters (LVEDVI, LVESVI, LVEF, LVGLS, SVI), and laboratory variables (albumin, GFR, NT-proBNP). In the multiple linear regression analysis, dyspnea proved to be a significant predictor of higher PHQ-9 and MLHFQ scores, even after adjusting for potential confounders. High symptom burden due to psychological distress is common among patients with HFrEF and HFmrEF. More efficient control of congestion may improve depression, anxiety symptoms, and health-related quality of life.

Keywords: anxiety; depression; heart failure; heart failure with mildly reduced ejection fraction; heart failure with reduced ejection fraction.

Grants and funding

This work was supported by the Collegium Talentum 2022 Programme of Hungary research bursary for first author T.M.S.