Skip to main content
SpringerLink
Log in

Effects of clinical depression on left ventricular dysfunction in patients with acute coronary syndrome

  • Published:
Journal of Thrombosis and Thrombolysis Aims and scope Submit manuscript

Abstract

Depression is associated with heart failure independent of traditional cardiovascular disease risk factors. Enhanced platelet activation has been suggested as a potential mechanism and has been associated with negative inotropic effects that can affect left ventricular ejection fraction (LVEF). We examined 131 consecutive acute coronary syndrome (ACS) patients to assess whether depression increased the risk for developing LV dysfunction, and to determine the effects of platelet serotonin signaling in this relationship. Major depression was assessed using the Structured Clinical Interview and depressive symptoms were measured using the Beck Depression Inventory (BDI), with BDI ≥ 10 defined as abnormal. LV dysfunction was defined as LVEF ≤ 45%. Platelet serotonin response was measured by serotonin augmented platelet aggregation and platelet serotonin receptor density. Mean age of ACS participants was 59 years, 78.6% male and 74.0% Caucasian. 34.4% of patients had a reduced LVEF ≤ 45% on presentation. Almost half (47.0%) of patients had BDI ≥ 10 and 18.0% had major depressive disorder. Platelet serotonin response was found to be augmented in depressed patients with low LVEF compared to depressed patients with normal LVEF (p < 0.020). However, the presence of LV dysfunction was found to be similar in both depressed (32.3%) and non-depressed (36.2%) patients (p = 0.714). This suggests alternative factors contribute to poor cardiovascular outcomes in depressed patients that are independent of LV function in post ACS patients.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Availability of data and material

Raw data available on open science framework https://osf.io/hyj69/?view_only=35a1d31edd8740309b24ae5d96502e7e.

Abbreviations

ACS:

Acute coronary syndrome

LVEF:

Left ventricular ejection fraction

MDD:

Major depressive disorder

BDI:

Beck Depression Inventory

SCID:

Structured clinical inventory for depression

IQR:

Interquartile range

CAD:

Coronary artery disease

CVD:

Cardiovascular disease

References

  1. Carney RM, Blumenthal JA, Catellier D et al (2003) Depression as a risk factor for mortality after acute myocardial infarction. Am J Cardiol 92(11):1277–1281

    PubMed  Google Scholar 

  2. Carney RM, Rich MW, Freedland KE et al (1988) Major depressive disorder predicts cardiac events in patients with coronary artery disease. Psychosom Med 50:627–733

    CAS  PubMed  Google Scholar 

  3. Frasure-Smith N, Lespérance F, Juneau M, Talajic M, Bourassa MG (1999) Gender, depression, and one-year prognosis after myocardial infarction. Psychosom Med 61(1):26–37

    CAS  PubMed  Google Scholar 

  4. Musselman DL, Evans DL, Nemeroff CB (2003) The relationship of depression to cardiovascular disease. Arch Gen Psychiatry 55:580–592

    Google Scholar 

  5. Frasure-Smith N, Lespérance F, Talajic M (1995) Depression and 18-month prognosis after myocardial infarction. Circulation 91:99–1005

    Google Scholar 

  6. Ziegelstein RC (2001) Depression after myocardial infarction. Cardiol Rev 9(1):45–51

    CAS  PubMed  Google Scholar 

  7. Carney RM, Freedland KE (2008) Depression in patients with coronary heart disease. Am J Med 121(11):S20–S27

    PubMed  Google Scholar 

  8. Thombs BD, De Jonge P, Coyne JC et al (2008) Depression screening and patient outcomes in cardiovascular care: a systematic review. JAMA 300:2161–2171

    CAS  PubMed  Google Scholar 

  9. Lespérance F, Frasure-Smith N, Juneau M, Théroux P (2000) Depression and 1-year prognosis in unstable angina. Arch Intern Med 160:1354–1360

    PubMed  Google Scholar 

  10. Shimbo D, Child J, Davidson K et al (2002) Exaggerated serotonin-mediated platelet reactivity as a possible link in depression and acute coronary syndromes. Am J Cardiol 89(3):331–333

    CAS  PubMed  Google Scholar 

  11. Morel-Kopp M, Mclean L, Chen Q et al (2009) The association of depression with platelet activation: evidence for a treatment effect. J Thromb Haemost 7(4):573–581

    PubMed  Google Scholar 

  12. Musselman DL, Tomer A, Manatunga AK et al (1996) Exaggerated platelet reactivity in major depression. Am J Psychiatry 153(10):1313–1317

    CAS  PubMed  Google Scholar 

  13. Ziegelstein RC, Parakh K, Sakhuja A, Bhat U (2009) Platelet function in patients with major depression. Intern Med J 39(1):38–43

    CAS  PubMed  Google Scholar 

  14. Zafar MU, Paz-Yepes M, Shimbo D et al (2010) Anxiety is a better predictor of platelet reactivity in coronary artery disease patients than depression. Eur Heart J 31:1573–1582

    PubMed  PubMed Central  Google Scholar 

  15. Williams MS, Ziegelstein RC, McCann UD, Gould NF, Ashvetiya T, Vaidya D (2019) Platelet serotonin signaling in patients with cardiovascular disease and comorbid depression. Psychosom Med 81:352–362

    CAS  PubMed  PubMed Central  Google Scholar 

  16. Fujita S, Takeda Y, Kizawa S et al (2015) Platelet volume indices are associated with systolic and diastolic cardiac dysfunction, and left ventricular hypertrophy. BMC Cardiovasc Disord 15:52

    PubMed  PubMed Central  Google Scholar 

  17. Yazici HU, Poyraz F, Sen N et al (2011) Relationship between mean platelet volume and left ventricular systolic function in patients with metabolic syndrome and ST-elevation myocardial infarction. Clin Investig Med 34:E330

    Google Scholar 

  18. Jiang W, Boyle SH, Ortel TL et al (2015) Platelet aggregation and mental stress induced myocardial ischemia: results from the Responses of Myocardial Ischemia to Escitalopram Treatment (REMIT) study. Am Heart J 169:496–507

    PubMed  Google Scholar 

  19. Angaran P, Dorian P, Ha ACT et al (2020) Association of left ventricular ejection fraction with mortality and hospitalizations. J Am Soc Echocardiogr. https://doi.org/10.1016/j.echo.2019.12.016

    Article  PubMed  Google Scholar 

  20. Miller AL, Dib C, Li L et al (2012) Left ventricular ejection fraction assessment among patients with acute myocardial infarction and its association with hospital quality of care and evidence-based therapy use. Circ Cardiovasc Qual Outcomes 5:662–667

    PubMed  Google Scholar 

  21. Parodi G, Antoniucci D (2010) Left ventricular remodeling after primary percutaneous coronary intervention. Am Heart J 160:S11–S15

    PubMed  Google Scholar 

  22. Mendis S, Thygesen K, Kuulasmaa K et al (2011) World Health Organization definition of myocardial infarction: 2008-09 revision. Int J Epidemiol 40:139–146

    PubMed  Google Scholar 

  23. Yancy CW, Jessup M, Bozkurt B et al (2013) 2013 ACCF/AHA guideline for the management of heart failure: executive summary: a report of the American college of cardiology foundation/American Heart Association task force on practice guidelines. Circulation 128:1810–1852

    PubMed  Google Scholar 

  24. Hsu JJ, Ziaeian B, Fonarow GC (2017) Heart failure with mid-range (borderline) ejection fraction. JACC Heart Fail 5:763–771

    PubMed  PubMed Central  Google Scholar 

  25. First MB, Spitzer RL, Gibbon M, Williams JBW (2002) Structured clinical interview for DSM-IV axis I disorders, research version, patient edition (SCID-I/P). Biometrics Research, New York State Psychiatric Institude, New York

    Google Scholar 

  26. Beck AT, Steer RA, Brown GK (1996) Manual for the Beck Depression Inventory-II. TX Psychol Corp, San Antonio

    Google Scholar 

  27. Arranz B, Rosel P, Sarró S et al (2003) Altered platelet serotonin 5-HT2A receptor density but not second messenger inositol trisphosphate levels in drug-free schizophrenic patients. Psychiatry Res 118:165–174

    CAS  PubMed  Google Scholar 

  28. Lv J, Liu F (2017) The role of serotonin beyond the central nervous system during embryogenesis. Front Cell Neurosci 11:74

    PubMed  PubMed Central  Google Scholar 

  29. Ayme-Dietrich E, Aubertin-Kirch G, Maroteaux L, Monassier L (2017) Cardiovascular remodeling and the peripheral serotonergic system. Arch Cardiovasc Dis 110(1):51–59

    PubMed  Google Scholar 

  30. Williams MS (2012) Platelets and depression in cardiovascular disease: a brief review of the current literature. World J Psychiatry 2:114–123

    PubMed  PubMed Central  Google Scholar 

  31. Mendelson SD (2000) The current status of the platelet 5-HT(2A) receptor in depression. J Affect Disord 57:13–24

    CAS  PubMed  Google Scholar 

  32. Hrdina PD, Bakish D, Chudzik J, Ravindran A, Lapierre YD (1995) Serotonergic markers in platelets of patients with major depression: upregulation of 5-HT2 receptors. J Psychiatry Neurosci 20:11–19

    CAS  PubMed  PubMed Central  Google Scholar 

  33. Sheline YI, Bardgett ME, Jackson JL, Newcomer JW, Csernansky JG (1995) Platelet serotonin markers and depressive symptomatology. Biol Psychiatry 37:442–447

    CAS  PubMed  Google Scholar 

  34. Rao ML, Hawellek B, Papassotiropoulos A, Deister A, Frahnert C (1998) Upregulation of the platelet serotonin(2A) receptor and low blood serotonin in suicidal psychiatric patients. Neuropsychobiology 38:84–89

    CAS  PubMed  Google Scholar 

  35. Berger JS, Becker RC, Kuhn C, Helms MJ, Ortel TL, Williams R (2013) Hyperreactive platelet phenotypes: relationship to altered serotonin transporter number, transport kinetics and intrinsic response to adrenergic co-stimulation. Thromb Haemost 109:85

    CAS  PubMed  Google Scholar 

  36. Lett H, Ali S, Whooley M (2008) Depression and cardiac function in patients with stable coronary heart disease: findings from the heart and soul study. Psychosom Med 70:444–449

    PubMed  PubMed Central  Google Scholar 

  37. Spijkerman TA, Van Den Brink RHS, Jansen JHC, Crijns HJGM, Ormel J (2005) Who is at risk of post-MI depressive symptoms? J Psychosom Res 58(5):425–432

    PubMed  Google Scholar 

  38. Lespérance F, Frasure-Smith N, Talajic M (1996) Major depression before and after myocardial infarction: its nature and consequences. Psychosom Med 58(2):99–110

    PubMed  Google Scholar 

  39. Strik JJMH, Lousberg R, Cheriex EC, Honig A (2004) One year cumulative incidence of depression following myocardial infarction and impact on cardiac outcome. J Psychosom Res 56:59–66

    PubMed  Google Scholar 

  40. Bush DE, Ziegelstein RC, Tayback M et al (2001) Even minimal symptoms of depression increase mortality risk after acute myocardial infarction. Am J Cardiol 88:337–341

    CAS  PubMed  Google Scholar 

  41. Kim Y-H, Kim SH, Lim SY et al (2012) Relationship between depression and subclinical left ventricular changes in the general population. Heart 98(18):1378–1383

    PubMed  Google Scholar 

  42. Carney RM, Freedland KE, Veith RC (2005) Depression, the autonomic nervous system, and coronary heart disease. Psychosom Med 67(SUPPL. 1):S29–S33

    PubMed  Google Scholar 

  43. Kent LK, Shapiro PA (2009) Depression and related psychological factors in heart disease. Harv Rev Psychiatry 17(6):377–388

    PubMed  Google Scholar 

  44. Denollet J, de Jonge P, Kuyper A et al (2009) Depression and type D personality represent different forms of distress in the Myocardial INfarction and Depression—Intervention Trial (MIND-IT). Psychol Med 39(05):749–756

    CAS  PubMed  Google Scholar 

  45. Welin C, Lappas G, Wilhelmsen L (2000) Independent importance of psychosocial factors for prognosis after myocardial infarction. J Intern Med 247:629–639

    CAS  PubMed  Google Scholar 

Download references

Funding

MW was funded by Grant RO1 HL096694 from the United States National Heart, Lung, and Blood Institute (Bethesda, MD). D.V. was supported by the Johns Hopkins Biostatistics, Epidemiology and Data Management Core.

Author information

Authors and Affiliations

  1. Division of Cardiology, Johns Hopkins Bayview Medical Center, Baltimore, MD, 21224, USA

    Jacob Sama, Dhananjay Vaidya, Monica Mukherjee & Marlene Williams

Authors
  1. Jacob Sama
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dhananjay Vaidya
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Monica Mukherjee
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marlene Williams
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the preparation of the manuscript significantly and are in agreement with the content. Material preparation and data collection were performed by MW and JS. DV performed statistical analysis. The first draft of manuscript written by JS and all authors commented on previous versions of manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jacob Sama.

Ethics declarations

Conflict of interest

MW serves on the speaker’s bureau of Maryland State Medical Society and Rockpointe Corporation that is supported by an unrestricted educational grant from AstraZeneca. The other authors report no conflicts of interest.

Consent to participate

Informed consent was obtained from all individual participants included in the study.

Ethics approval

This study was approved by the Johns Hopkins institutional review board

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Sama, J., Vaidya, D., Mukherjee, M. et al. Effects of clinical depression on left ventricular dysfunction in patients with acute coronary syndrome. J Thromb Thrombolysis 51, 693–700 (2021). https://doi.org/10.1007/s11239-020-02268-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11239-020-02268-4

Keywords

Search

Navigation