Author + information
- Süleyman Karakoyun1,
- Mustafa Ozan Gürsoy2,
- Selim Topçu3,
- Kamuran Kalkan3,
- Mustafa Yurttaş4,
- Tayyar Gökdeniz5 and
- Enbiya Aksakal3
Heart failure is one of the leading causes of morbidity and mortality worldwide. Multiple studies have studied the relationship between heart failure and development of depression. In this study, we aimed to evaluate the left ventricle global longitudinal strain (LV-GLS) and torsion changes in heart failure reduced ejection fraction (EF) patients in association with severity of depressive symptoms using speckle tracking echocardiography (STE).
Between December 2012 and April 2013, 86 patients with chronic heart failure (LV-EF <35%) were included in this study. Severity of depression was assessed using Beck Depression Inventory (BDI). Patients who were mentally subnormal or who had other neurological problems were excluded. Informed consent was obtained from each patient. Patients with depression were classified as follows: Minimal with score 0–13 (group 1), mild with score 14–19 (group 2), moderate with score 20–28 (group 3), and severe with score 29–63 (group 4). In STE study, LV apical long, four- and two-chamber images and short-axis views at basal, mid-papillary and apical levels at frame rates between 40 and 80 frames/s were used for assessment of 2 dimensional LV-GLS.
The mean age of the study population was 62±12 (F: 38, M: 48). There were no significant differences between groups regarding age, gender, LV-EF and LV systolic/diastolic dimensions. The groups (1-4), which were classified in terms of BDI scoring system, included 19, 23, 21 and 23 patients, respectively. The median New York Heart Association (NYHA) class of group 4 was significantly higher than that of group 1, 2 and 3. Systolic pulmonary artery pressure (PABs) was compared between the 4 groups (38 mmHg, 40 mmHg, 43 mmHg, 60 mmHg, respectively; p= 0.035). Post-hoc test showed significantly higher PABs in the group 4 compared to the others. In the analysis carried out between groups, GLS values were found to be significantly lower in the group 3 and 4 compared to the group 1 and group 2 (19.3±2.1, 18.4±1.77, 16.5±1.1, 16.1±1.18, respectively; p=0.027) showing the association between severity of depression and left ventricule GLS. There was no statistical difference in terms of torsion levels (9,5±5.3, 9,5±4,8 9,3±4,4 8,9±5,1, respectively; p=0.218).
The severity of depression poses clinical significance for patients with heart failure. Left ventricule GLS and PABs may be significantly impaired in patients with development of severe depressive symptoms.