Yaygın Anksiyete Bozukluğu Olan Hastaların Trombosit Parametreleri ve Elektrokardiyogram Verilerinin Sağlıklı Kontrol Grubu ile Karşılaştırılması

Yıl 2023, Cilt: 5 Sayı: 2, 228 - 30, 15.05.2023

Yaşar Kapıcı , Sabri Abuş , Selçuk Ayhan , Hakan Tibilli , Ahmet Akçay

https://doi.org/10.37990/medr.1173121

Öz

Amaç: Yaygın anksiyete bozukluğu (YAB) olan hastalarda artmış kalp hastalığı tehdidi hakkında sınırlı veri bulunmaktadır. Geniş frontal QRS-T açısı (fQRS-T), birçok farklı hasta grubunda kardiyovasküler hastalık riskinin artmasıyla ilişkilendirilmiştir.
Materyal ve Metot: Bu çalışmada YAB tanısı almış 70 hastanın sosyodemografik özellikleri, elektrokardiyogram (EKG) parametreleri ve laboratuvar değerleri 80 sağlıklı kontrol (SK) ile karşılaştırıldı. YAB'de kardiyovasküler hastalık riskini EKG parametreleri üzerinden yorumlamayı amaçladık.
Bulgular: İstatistiksel analize göre, YAB'li hastalarda fQRS-T, SK'ye göre daha genişti (p<0,001). Buna göre YAB'li hastalarda bazofil sayısı istatistiksel olarak daha düşüktü (p<0,001). Eozinofil sayısı ve ortalama trombosit hacmi (MPV) YAB'li hastalarda anlamlı olarak yüksekti (sırasıyla p=0,019 ve p=0,003). Buna göre, fQRS-T ve MPV yüksek derecede koreledir (p<0,001). Yaygın Anksiyete Bozukluğu Testi-7 skoru (GAD-7) ve fQRS-T arasında pozitif korelasyon vardı (p=0,001). fQRS-T için lineer regresyon analizine göre MPV ve YAB-7 puanları fQRS-T'yi pozitif ve anlamlı olarak yordamaktadır (sırasıyla p<0,001 ve p=0,036).
Sonuç: Bu çalışma literatürde YAB'li hastalarda fQRS-T'yi inceleyen ilk çalışmadır. Bu çalışmada, MPV'nin YAB'de fQRS-T'yi öngördüğünü keşfettik. Gelecekteki çalışmalar, anksiyete bozukluklarında trombosit disfonksiyonunu gösteren yöntemleri kullanarak kardiyovasküler riski öngörmede önemli olacaktır.

Anahtar Kelimeler

Yaygın anksiyete bozukluğu , ortalama trombosit hacmi , frontal QRS-T açısı

Comparison of Platelet Parameters and Electrocardiogram Data in Patients with Generalized Anxiety Disorder with Healthy Control Group

Öz

Aim: Generalized anxiety disorder (GAD) refers to the intense stress and tension felt in the face of various life events. Various studies have shown that cardiovascular diseases are more common in patients with anxiety. Frontal QRS-T (fQRS-T) has been shown to be elevated in cardiovascular diseases. In this study, the fQRS-T, hemogram, and biochemistry values of patients with GAD were compared with healthy controls (HC) and the cardiovascular risk status of GAD patients was evaluated.
Material and Methods: Seventy patients with a diagnosis of GAD and no comorbidity followed in the district state hospital's psychiatry outpatient clinic were included in this study. Sociodemographic data, disease severity, hemogram, biochemistry values, electrocardiogram (ECG) data of these patients were recorded. Disease severity was evaluated with The Generalized Anxiety Disorder Test-7 (GAD-7). These values were compared with 80 HCs without any psychiatric or organic disease. The correlation of fQRS-T value with platelet parameters and age was investigated in GAD patients.
Results: According to the statistical analysis, fQRS-T was wider in patients with GAD than in HC (p<.001). Accordingly, basophil count was statistically lower in patients with GAD (p<.001). Eosinophil count and mean platelet volume (MPV) were significantly elevated in patients with GAD (p=.019 and p=.003 respectively). Accordingly, fQRS-T and MPV are highly correlated (p<.001). The GAD-7 score and fQRS-T were positively correlated (p=.001). According to the linear regression analysis for fQRS-T, MPV and GAD-7 scores positively and significantly predict fQRS-T (p<.001 and p=.036 respectively).
Conclusion: This study is the first in the literature to examine fQRS-T in patients with GAD. In this study, we discovered that MPV predicts fQRS-T in GAD. Future studies are essential in predicting cardiovascular risk using methods demonstrating platelet dysfunction in anxiety disorders.

Anahtar Kelimeler

Generalized anxiety disorder , mean platelet volume , frontal QRS-T angle

Kaynakça

• 1. Wittchen HU, Hoyer J. Generalized anxiety disorder: nature and course. J Clin Psychiatry. 2001;62:15-21.
• 2. Wittchen HU. Generalized anxiety disorder: prevalence, burden, and cost to society. Depress Anxiety. 2002;16:162-71.
• 3. Liu H, Tian Y, Liu Y, Nigatu YT, Wang J. Relationship between major depressive disorder, generalized anxiety disorder and coronary artery disease in the US general population. J Psychosom Res. 2019;119:8-13.
• 4. Dilaveris P, Gialafos E, Pantazis A, Synetos A, Triposkiadis F, Gialafos J. The spatial QRS-T angle as a marker of ventricular repolarisation in hypertension. J Hum Hypertens. 2001;15:63-70.
• 5. Oehler A, Feldman T, Henrikson CA, Tereshchenko LG. QRS-T angle: a review. Ann Noninvasive Electrocardiol. 2014;19:534-42.
• 6. American Psychiatric Association, 2013. Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5th ed. Arlington: American Psychiatric Publishing.
• 7. Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166:1092-7.
• 8. Konkan R, Şenormancı Ö, Güçlü O, Aydın E, Sungur MZ. Validity and reliability study for the Turkish adaptation of the Generalized Anxiety Disorder-7 (GAD-7) scale. Arch. Neuropsychiat. 2013;50:53-8.
• 9. Aro AL, Huikuri HV, Tikkanen JT, et al. QRS-T angle as a predictor of sudden cardiac death in a middle-aged general population. Europace. 2012;14:872-6.
• 10. Celano CM, Daunis DJ, Lokko HN, Campbell KA, Huffman JC. Anxiety Disorders and Cardiovascular Disease. Curr Psychiatry Rep. 2016;18:101.
• 11. Tully PJ, Cosh SM. Generalized anxiety disorder prevalence and comorbidity with depression in coronary heart disease: a meta-analysis. J Health Psychol. 2013;18:1601–16.
• 12. Hoge EA, Ivkovic A, Fricchione GL. Generalized anxiety disorder: diagnosis and treatment. BMJ 2012;345:e7500.
• 13. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE. Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):617–27.
• 14. Ross R. Atherosclerosis--an inflammatory disease. N Engl J Med. 1999;340:115–26.
• 15. Moyer CF, Sajuthi D, Tulli H, Williams JK. Synthesis of IL-1 alpha and IL-1 beta by arterial cells in atherosclerosis. Am J Pathol. 1991;138:951–60.
• 16. Hohensinner PJ, Niessner A, Huber K, Weyand CM, Wojta J. Inflammation and cardiac outcome. Curr Opin Infect Dis. 2011;24:259–64.
• 17. Hasper D, Hummel M, Kleber FX, Reindl I, Volk HD. Systemic inflammation in patients with heart failure. Eur Heart J. 1998;19:761–5.
• 18.Vasan RS, Sullivan LM, Roubenoff R, et al. Inflammatory markers and risk of heart failure in elderly subjects without prior myocardial infarction: the Framingham Heart Study. Circulation. 2003;107:1486–91.
• 19. Lindahl B, Toss H, Siegbahn A, Venge P, Wallentin L. Markers of myocardial damage and inflammation in relation to long-term mortality in unstable coronary artery disease. FRISC Study Group. Fragmin during Instability in Coronary Artery Disease. N Engl J Med. 2000;343: 1139–47.
• 20. von Känel R, Hepp U, Kraemer B, et al. Evidence for low-grade systemic proinflammatory activity in patients with posttraumatic stress disorder. J Psychiatr Res. 2007;41:744-52.
• 21. Passos IC, Vasconcelos-Moreno MP, Costa LG, et al. Inflammatory markers in post-traumatic stress disorder: a systematic review, meta-analysis, and meta-regression. Lancet Psychiatry. 2015;2:1002-12.
• 22.Heitzer T, Schlinzig T, Krohn K, Meinertz T, Munzel T. Endothelial dysfunction, oxidative stress, and risk of cardiovascular events in patients with coronary artery disease. Circulation. 2001;104:2673–8.
• 23.Drexler H. Endothelial dysfunction: clinical implications. Prog Cardiovasc Dis. 1997;39:287– 324.
• 24. Narita K, Murata T, Hamada T, et al. Interactions among higher trait anxiety, sympathetic activity, and endothelial function in the elderly. J Psychiatr Res. 2007;41:418-27.
• 25. Narita K, Murata T, Hamada T, et al. Association between trait anxiety and endothelial function observed in elderly males but not in young males. Int Psychogeriatr. 2007;19:947-54.
• 26. Mercer DA, Lavoie KL, Ditto B, et al. The interaction between anxiety and depressive symptoms on brachial artery reactivity in cardiac patients. Biol Psychol. 2014;102:44-50.
• 27. Harris KF, Matthews KA, Sutton-Tyrrell K, Kuller LH. Associations between psychological traits and endothelial function in postmenopausal women. Psychosom Med. 2003;65:402–9.
• 28. Felice F, Di Stefano R, Pini S, et al. Influence of depression and anxiety on circulating endothelial progenitor cells in patients with acute coronary syndromes. Hum Psychopharmacol. 2015;30:183-8.
• 29. Vidović A, Grubišić-Ilić M, Kozarić-Kovačić D, et al. Exaggerated platelet reactivity to physiological agonists in war veterans with posttraumatic stress disorder. Psychoneuroendocrinology. 2011;36:161-72.
• 30. Garvey MJ, Noyes R, Woodman C, Laukes C. The association of urinary 5-hydroxyindoleacetic acid and vanillylmandelic acid in patients with generalized anxiety. Neuropsychobiology. 1995;31:6–9.
• 31. Neumeister A, Bain E, Nugent AC, et al. Reduced serotonin type 1A receptor binding in panic disorder. J Neurosci. 2004;24:589-91.
• 32. Miyata K, Shimokawa H, Higo T, et al. Sarpogrelate, a selective 5-HT2A serotonergic receptor antagonist, inhibits serotonin-induced coronary artery spasm in a porcine model. J Cardiovasc Pharmacol. 2000;35:294-301.
• 33. Vikenes K, Farstad M, Nordrehaug JE. Serotonin is associated with coronary artery disease and cardiac events. Circulation. 1999;100:483–9.
• 34. Strike PC, Magid K, Brydon L, Edwards S, McEwan JR, Steptoe A. Exaggerated platelet and hemodynamic reactivity to mental stress in men with coronary artery disease. Psychosom Med. 2004;66:492-500.
• 35. Levine SP, Towell BL, Suarez AM, Knieriem LK, Harris MM, George JN. Platelet activation and secretion associated with emotional stress. Circulation. 1985;71:1129–34.
• 36. Bedi US, Arora R. Cardiovascular manifestations of posttraumatic stress disorder. J Natl Med Assoc. 2007;99:642–9.
• 37. Yapislar H, Aydogan S, Ozum U. Biological understanding of the cardiovascular risk associated with major depression and panic disorder is important. Int J Psychiatry Clin Pract. 2012;16:27– 32.
• 38. Camacho A, Dimsdale JE. Platelets and psychiatry: lessons learned from old and new studies. Psychosom Med. 2000;62:326–36.
• 39. Huczek Z, Kochman J, Filipiak KJ, et al. Mean platelet volume on admission predicts impaired reperfusion and long-term mortality in acute myocardial infarction treated with primary percutaneous coronary intervention. J Am Coll Cardiol. 2005;46:284-90.
• 40. Slavka G, Perkmann T, Haslacher H, et al. Mean platelet volume may represent a predictive parameter for overall vascular mortality and ischemic heart disease. Arterioscler Thromb Vasc Biol. 2011;31:1215-8.
• 41. Kandis H, Ozhan H, Ordu S, et al. The prognostic value of mean platelet volume in decompensated heart failure. Emerg Med J. 2011;28:575-8.