Autonomic cardiovascular dysregulation as a potential mechanism underlying depression and coronary artery bypass grafting surgery outcomes

Abstract

BackgroundCoronary artery bypass grafting (CABG) is often used to treat patients with significant coronary heart disease (CHD). To date, multiple longitudinal and cross-sectional studies have examined the association between depression and CABG outcomes. Although this relationship is well established, the mechanism underlying this relationship remains unclear. The purpose of this study was twofold. First, we compared three markers of autonomic nervous system (ANS) function in four groups of patients: 1) Patients with coronary heart disease and depression (CHD/Dep), 2) Patients without CHD but with depression (NonCHD/Dep), 3) Patients with CHD but without depression (CHD/NonDep), and 4) Patients without CHD and depression (NonCHD/NonDep). Second, we investigated the impact of depression and autonomic nervous system activity on CABG outcomes.MethodsPatients were screened to determine whether they met some of the study's inclusion or exclusion criteria. ANS function (i.e., heart rate, heart rate variability, and plasma norepinephrine levels) were measured. Chi-square and one-way analysis of variance were performed to evaluate group differences across demographic, medical variables, and indicators of ANS function. Logistic regression and multiple regression analyses were used to assess impact of depression and autonomic nervous system activity on CABG outcomes.ResultsThe results of the study provide some support to suggest that depressed patients with CHD have greater ANS dysregulation compared to those with only CHD or depression. Furthermore, independent predictors of in-hospital length of stay and non-routine discharge included having a diagnosis of depression and CHD, elevated heart rate, and low heart rate variability.ConclusionsThe current study presents evidence to support the hypothesis that ANS dysregulation might be one of the underlying mechanisms that links depression to cardiovascular CABG surgery outcomes. Thus, future studies should focus on developing and testing interventions that targets modifying ANS dysregulation, which may lead to improved patient outcomes.

The role of neutrophil gelatinase associated lipocalin (NGAL) as biological constituent linking depression and cardiovascular disease

“…Besides psychological factors and behavioral factors Ziegelstein et al, 2000), endothelial dysfunction (Celano and Huffman, 2011;Pizzi et al, 2009), increased platelet activity (Celano and Huffman, 2011;Schins et al, 2004), autonomic nervous system dysfunction (Dao et al, 2010;Kop et al, 2010) and inflammation are possible factors having a role in the interaction between cardiovascular disease and depression. For this review we will focus on inflammation.…”

The relation of depression to in-hospital outcomes among adults hospitalized for firearm-related injury

“…length of stay at the hospital (Dao et al, 2010). Another example was that having depressive symptoms prior to injury was a risk factor for poor affective/behavioral, cognitive, and mental health-related quality-of-life outcomes in patients after mild traumatic brain injury (Kumar et al, 2014).…”

Psychiatric Factors Which Impact Coronary Heart Disease and Influence Outcomes Post-Coronary Artery Bypass Grafting Surgery

“…Also, the physiological profile of a Coronary Artery Bypass Grafting patients with Post-Traumatic Stress Disorder may be complicated given purported research that low Heart Rate Variability is related to cardiovascular disease (van der Kolk, 2006). As previously discussed, it has been reported that patients with Coronary Artery Disease and a diagnosis of Post-Traumatic Stress Disorder have lower Heart Rate Variability than those patients with Coronary Artery Disease alone (Dao et al, 2010a;Krittayaphong et al, 1997;Stein et al, 2000). Since Post-Traumatic Stress Disorder and cardiovascular disease are associated with decreased Heart Rate Variability and Autonomic Nervous System dysregulation, Heart Rate Variability biofeedback training may reduce complications post-surgery.…”

“…Specifically, long term treatments are unrealistic and unfeasible given the sudden onset of Coronary Artery Bypass Grafting surgeries (Doerfler et al, 1994). Since there is evidence that patients suffering from Post-Traumatic Stress Disorder have an increased likelihood of mortality following Coronary Artery Bypass Grafting surgery (Dao et al, 2010a), in combination with length of treatment necessary for effective Post-Traumatic Stress Disorder care, there is a necessary need for an effective, short term treatment for improving outcomes following Coronary Artery Bypass Grafting surgery. As mentioned earlier, Heart Rate Variability is a measure which examines the interplay between the parasympathetic and sympathetic influences on heart rate and represents the psychophysiological mechanism of emotion regulation (Appelhans & Luecken, 2006).…”