Pages 15-22

Öz

Increasing evidence reveals that depression is emerging as an independent cardiovascular disease (CVD) risk factor. We investigated whether treating depression with seratonin reuptake inhibitors (SSRI) would effect echocardiographic systolic and diastolic functions, in addition endothelial function and arterial stiffnes indexes which are known CVD risk factors Fourtyone patients who were prescribed SSRI therapy for the first time due to major depression without known CVD and between 16-65 years of age were included. At the beginning of the study and after 8 weeks of SSRI therapy patients were underwent echocardiographic analysis of systolic and diastolic parameters, myocardial performance index (MPI) and aortic strain (Ao strain). Also by finger plethysmography with the aid of an auto-analyser pulse wave analysis were done and pulse propagation time (PPT), stiffness index (SI) and reflection index (RI) were measured. Endothelial functions were estimated with flow mediated dilatation method. Nineteen patients (46.3%) came to control visit after 8 weeks of therapy and the final analysis was done with their results. Compared to beginning, 8 weeks of therapy with SSRI resulted in an increase in systolic ejection fraction (%64,83±4,54 vs %66,80±3,3, p=0,020) and fractional shortening (%35,39±3,53 vs %37,11±2,49, p=0,013) and decrease in MPI (0,60±0,21 vs 0,45±0,15, p=0,004). The other parameters including left ventricular diastolic functions, aortic strain, endothelial function and aortic stiffness parameters were not significantly effected. Our results imply that short term therapy with SSRI in patients with newly diagnosed depression might favorably effect the left ventricular systolic functions whereas left ventricular diastolic functions, endothelial functions and aortic stifness parameters remain unchanged.

Anahtar Kelimeler

• Depression, endothelial function, srterial stiffness, echocardiography

Depresyon Hastalarında Endotel Fonksiyonları, Ekokardiyografik Parametreler ve Damar Sertliğine Antidepresan Tedavinin Etkisi

Öz

Giderek artan bilgiler depresyonun bağımsız bir kardiyovasküler hastalık (KVH) risk faktörü olduğunu ortaya koymaktadır. Bu çalışmamızda seratonin geri alım inhibitörleri (SSRI) ile tedavinin kalbin sistolik ve diyastolik fonksiyonları ve kardiyovasküler hastalık gelişimi için bağımsız öngördürücüler olan aortik sertlik ve endotel fonksiyon parametreleri üzerine etkisini araştırdık. Çalışmaya 16-65 yaş arası bilinen KVH öyküsü olmayan ve major depresyon nedeni ile ilk defa SSRI tedavisi başlanan 41 hasta dâhil edildi. Tedavi başlangıcında ve 8 haftalık tedavi sonunda hastaların ekokardiyografik olarak sistolik ve diyastolik fonksiyon parametreleri, miyokard performans indeksi (MPI) ve aortikgerilim (Ao strain) değerlendirildi. Otomatik analizör ile parmaktan pletismografik yöntemle yapılan nabız dalga analizi ile belirlenen nabız ilerleme zamanı (PPT), sertlik indeksi (SI) ve Refleksiyon indeksi (RI) hesaplandı. Endotel fonksiyonları akıma bağlı dilatasyon yöntemi ile değerlendirildi. Sekiz haftalık tedavi sonunda 19 hasta kontrole geldi (%46,3) ve nihai değerlendirmeye bu hastaların sonuçları dâhil edildi. Analiz yapılan hastaların tedavi öncesine göre tedavi sonunda sol ventrikül ejeksiyon fraksiyonunun (%64,83±4,54 vs %66,80±3,3, p=0,020) ve fraksiyonel kısalmasının arttığı (%35,39±3,53 vs %37,11±2,49, p=0,013), MPI değerinin düştüğü gözlendi (0,60±0,21 vs 0,45±0,15, p=0,004). Bunun dışında diyastolik fonksiyon parametreleri,aortik strain, endotel fonksiyon ve aortik sertlik parametreleri açısından tedavi sonrasında anlamlı farklılık izlenmedi. Çalışmamız yeni tanı konmuş depresyonlu hastaların SSRI inhibitörü ile kısa dönem tedavilerinin sol ventrikül sistolik fonksiyonlarını olumlu yönde etkileyebileceğini, diyastolik fonksiyonlarda, endotel fonksiyonlarında ve büyük arter sertliğinde ise değişiklik yapmadığını gösterdi.

Anahtar Kelimeler

• Depresyon, endotel fonksiyonları, damar sertliği, ekokardiyografi

Kaynakça

1. 1. American heart Association Heart Disease and Stroke Statistics-2003 Update. Dallas, TX: AHA
2. 2. Murray CJ. The Global burden of Disease and Injury Series, Volume 1: A comprehensive Assessment of Mortality and Disability From Diseases, Injuries, and Risk factors in 1990 projected to 2020. Cambridge, MA: Harvard School of Public Health on behalf of the WHO and the World Bank, Harvard University Pres.
3. 3. Rabkin J, Charles E, Kass F. Hypertension and DSM-III depression in Psychiatric outpatients. AM J Psychiatry. 1983; 140 (8): 1072-4.
4. 4. Plante GE. Depression and cardiovascular disease: a reciprocal relationship Metabolism. 2005; 54(suppl 1): 45-8.
5. 5. Davidson K, Jonas BS, Dixon KE, Markovitz JH. Do depression symptoms predict early hypertension incidence in young adults in the CARDIA study? Coronary Artery Risk Development in Young Adults. Arch Intern Med. 2000; 160(10): 1495-500.
6. 6. Everson AS, Kaplan GA, Goldberg DE, Salomen JT. Hypertension incidence is predicted by high levels of hopelessness in Finish men. Hypertension. 2000; 34(2): 561-7.
7. 7. Abramson J, Berger A, Krumholz HM, Vaccarino V. Depression and risk of heart failure among older persons with isolated systolic hypertension. Arch Intern Med. 2001; 161(14): 1725-30.
8. 8. Anda R., Williamson D., Jones D., Macera C., Eaker E., Glassman A. Depressed affect, hopelessness, and the risk of ischemic heart disease in a cohort of U.S. adults. Epidemiology. 1993;4: 285–294.

9. 9. Rudisch B, Nemeroff CB. Epidemiology of comorbid coronary artery disease and depression Biol Psychiatry. 2003; 54: 227-40.
10. 10. Frasure-Smith N, Lespérance F, Talajic M. JAMA. 1993;270(15): 1819-25.
11. 11. Lespérance F, Frasure-Smith N, Juneau M, Théroux P. Depression and 1-year prognosis in unstable angina. Arch Intern Med. 2000; 160(9): 1354-60.
12. 12. Wagner J, Tennen H, Mansoor G, Abbott G. Endothelial dysfunction and history of recurrent depression in postmenopausal women with Type 2 diabetes: a case-control study. J Diabetes Complications. 2008 Jan 11. [Epub ahead of print]
13. 13. Tomfohr LM, Martin TM, Miller GE. Symptoms of depression and impaired endothelial function in healthy adolescent women J Behav Med. 2007 Dec 29 [Epub ahead of print]
14. 14.Broadley AJ, Korszun A, Jones CJ, Frenneaux MP. Arterial endothelial function is impaired in treated depression. Heart. 2002; 88(5): 521-3.
15. 15. Steptoe A, Strike PC, Perkins-Porras L, McEwan JR, Whitehead DL. Acute depressed mood as a trigger of acute coronary syndromes. Biol Psychiatry. 2006; 60(8): 837-42. Epub 2006 Jun 14.
16. 16.Chrapko WE, Jurasz P, Radomski MW, Lara N, Archer SL, Le Mellédo JM. Decreased platelet nitric oxide synthase activity and plasma nitric oxide metabolites in major depressive disorder. Biol Psychiatry. 2004 ;56(2):129-34
17. 17.Joynt KE, Whellan DJ, O’Connor CM. Depression and Vardiovascular Disease: Mechanisms of Interaction BHiol Pstchiatry. 2003;54:248-61
18. 18. Kleiger RE, Miller JP, Bigger JT Jr, Moss AJ. Decreased heart rate variability and its association with increased mortality after acute myocardial infarction. Am J Cardiol. 1987 ;59(4):256-62.
19. 19. Pizzi C, Manzoli L, Mancini S, Costa GM. Analysis of potential predictors of depression among coronary heart disease risk factors including heart rate variability, markers of inflammation, and endothelial function. Eur Heart J. 2008; 29(9): 1110-7.
20. 20. Serebruany VL, Glassman AH, Malinin AI, Nemeroff CB, Musselman DL, van Zyl LT, Finkel MS, Krishnan KR, Gaffney M, Harrison W, Califf RM, O'Connor CM; Sertraline AntiDepressant Heart Attack Randomized Trial Study Group. Platelet/endothelial biomarkers in depressed patients treated with the selective serotonin reuptake inhibitor sertraline after acute coronary events: the Sertraline AntiDepressant Heart Attack Randomized Trial (SADHART) Platelet Substudy. Circulation. 2003; 108(8):939-44. 2003 Aug 11.
21. 21. Maurer-Spurej E. Biomedicine and diseases:review. Serotonin reuptake inhibitors and cardiovascular diseases: a platelet connection Cell Mol Life Sci . 2005; 62: 159-70
22. 22. van Zyl LT, Lespérance F, Frasure-Smith N, Malinin AI, Atar D, Laliberté MA, Serebruany VL. Platelet and endothelial activity in comorbid major depression and coronary artery disease patients treated with citalopram: the Canadian Cardiac Randomized Evaluation of Antidepressant and Psychotherapy Efficacy Trial (CREATE) biomarker sub-study. J Thromb Thrombolysis. 2008 Jan 11. [Epub ahead of print]
23. 23.Chigogidze T, Simonia G. Flow-mediated dilation in patients with left ventricular diastolic dysfunction Georgian Med News. 2005 ;(128):44-8
24. 24. Ma LN, Zhao SP, Gao M, Zhou QC, Fan P. Endothelial dysfunction associated with left ventricular diastolic dysfunction in patients with coronary heart disease. Int J Cardiol. 2000;72(3):275-9
25. 25. Masugata H, Senda S, Goda F, et al: Left ventricular diastolic dysfunction as assessed by echocardiography in metabolic syndrome. Hypertens Res. 2006; 29: 897–903
26. 26. Zizek B, Poredos B Increased left ventricular mass and diastolic dysfunction are associated with endothelial dysfunction in normotensive offspring of subjects with essential hypertension Blood Pressure. 2007; 16: 36–44
27. 27. Tavil Y, Ozturk MA, Sen N, Kaya MG, Hizal F, Poyraz F, Turfan M, Onder M, Gurer MA, Cengel A. The assessment of cardiac functions by tissue Doppler-derived myocardial performance index in patients with Behcet's disease. Clin Rheumatol. 2008;27(3):309-14. Epub 2007 Aug 3
28. 28. Sahn DJ, DeMaria A, Kisslo J, Weyman A.Circulation. Recommendations regarding quantitation in M-mode echocardiography: results of a survey of echocardiographic measurements. 1978; 58(6): 1072-83.
29. 29. Gulati VK, Katz WE, Follansbee WP, Gorcsan J 3rd (1996) Mitral annular descent velocity by tissue Doppler echocardiography as an index of global left ventricular function. Am J Cardiol. 1977: 979–984.
30. 30. Tei C, Ling LH, Hodge DO, Bailey KR, Oh JK, Rodeheffer RJ. New index of combined systolic and diastolic myocardial performance: a simple and reproducible measure of cardiac function–a study in normals and dilated cardiomyopathy. J Cardiol. 1995; 26: 357–366.
31. 31. Tei C, Nishimura RA, Seward JB, Tajik AJ Noninvasive Doppler-derived myocardial performance index: correlation with simultaneous measurements of cardiac catheterization measurements. J Am Soc Echocardiogr. 1997; 10: 169–178.
32. 32. Stefanadis C, Stratos C, Boudoulas H. Distensibility of the ascending aorta: comparison of invasive and non-invasive techniques in healthy men and in men with coronary artery disease. Eur Heart J. 1990; 11: 990–6.
33. 33. Pitsavos C, Toutouzas K, Dernellis J, Skoumas J, Skoumbourdis E, Stefanadis C, Toutouzas P , Aortic stiffness in young patients with heterozygous familial hypercholesterolemia. Am Heart J. 1998 ;135(4):604-8.
34. 34. Millasseau SC, Kelly RP, Ritter JM, Chowienczyk PJ. Determination of age-related increases in large artery stiffness by digital pulse contour analysis. Clinical Science. 2002; 103: 371–7.
35. 35. Millasseau SC, Guigui FG, Kelly RP, Prasad K, Cockcroft JR, Ritter JM, Chowienczyk PJ. Noninvasive assessment of the digital volume pulse: comparison with the peripheral pressure pulse. Hypertension. 2000; 36: 952-6.
36. 36.Chowienczyk PJ, Kelly RP, MacCallum H, Millasseau SC, Andersson TLG, Gosling RG, Ritter JM, Änggård EE. Photoplethysmographic assessment of pulse wave reflection. Blunted response to endothelium-dependent beta2- adrenergic vasodilation in type II diabetes mellitus. J Am Coll Cardiol. 1999; 34: 2007-14.
37. 37.Corretti MC, Anderson TJ, Benjamin EJ, Celermajer D, Charbonneau F, Creager MA, et al. Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery: A report of the International Brachial Artery Reactivity Task Force. J Am Coll Cardiol. 2002; 39: 257-265.
38. 38. Hashimoto M, Akishita M, Eto M, Ishikawa M, Kozaki K, Toba K, Sagara Y, Taketani Y, Orimo H, Ouchi Y. Modulation of endothelium-dependent flow-mediated dilatation of the brachial artery by sex and menstrual cycle. Circulation. 1995;92(12):3431-5.
39. 39.Boyle E, Chambers M. Medication compliance in older individuals with depression: gaining the views of family carers J Psychiatr Ment Health Nurs. 2000 ;7(6):515-22
40. 40. Waldenborg M, Soholat M, Kähäri A, Emilsson K, Fröbert O. Multidisciplinary assessment of tako tsubo cardiomyopathy: a prospective case study. MC Cardiovasc Disord. 2011;11:14. doi: 10.1186/1471-2261-11-14
41. 41. Yoshihiro J. Akashi, David S. Goldstein, Giuseppe Barbaro and Takashi Ueyama. Takotsubo Cardiomyopathy: A New Form of Acute, Reversible Heart Failure. Circulation. 2008;118:2754-62
42. 42.Jiang W, Samad Z, Boyle S, Becker RC, Williams R, Kuhn C, Ortel TL, Rogers J, Kuchibhatla M, O'Connor C, Velazquez EJ. Prevalence and clinical characteristics of mental stress-induced myocardial ischemia in patients with coronary heart disease. J Am Coll Cardiol. 2013; 61: 714–22.
43. 43. Pizzi C, Santarella L, Costa MG, Manfrini O, Flacco ME, Capasso L, Chiarini S, Di Baldassarre A, Manzoli L. Pathophysiological mechanisms linking depression and atherosclerosis: an overview. J Biol Regul Homeost Agents. 2012; 26(4): 775-82.
44. 44. Mortensen JK, Larsson H, Johnsen SP, Andersen G. Post stroke use of selective serotonin reuptake inhibitors and clinical outcome among patients with ischemic stroke: a nationwide propensity scorematched follow-up study. Stroke. 2013 Feb;44(2):420-6. doi: 10.1161/STROKEAHA.112.674242. Epub 2013 Jan 10.
45. 45.Jiang W, Velazquez EJ, Samad Z, Kuchibhatla M, Martsberger C, Rogers J, Williams R, Kuhn C, Ortel TL, Becker RC, Pristera N, Krishnan R, O'Connor CM. Responses of mental stress-induced myocardial ischemia to escitalopram treatment: background, design, and method for the Responses of Mental Stress Induced Myocardial Ischemia to Escitalopram Treatment trial. Am Heart J. 2012;163(1):20-6. doi: 10.1016/j.ahj.2011.09.018. Epub 2011 Nov 14.
46. 46.Cooper DC, Milic MS, Tafur JR, Mills PJ, Bardwell WA, Ziegler MG, Dimsdale JE. Adverse impact of mood on flow-mediated dilation. Psychosom Med. 2010;72(2):122-7. doi: 10.1097/PSY.0b013e3181cdbfc0. Epub 2010 Jan 25
47. 47.Broadley AJ, Korszun A, Jones CJ, Frenneaux MP. Arterial endothelial function is impaired in treated depression. Heart. 2002 ;88(5):521-3.
48. 48. Seldenrijk A, van Hout HP, van Marwijk HW, de Groot E, Gort J, Rustemeijer C, Diamant M, Penninx BW. Depression, anxiety, and arterial stiffness. Biol Psychiatry. 2011;69(8):795-803. doi: 10.1016/j.biopsych.2010.12.034. Epub 2011 Feb 2