Cardiac-related hospitalization and/or death associated with immune dysregulation and symptoms of depression in heart failure patients.

TitleCardiac-related hospitalization and/or death associated with immune dysregulation and symptoms of depression in heart failure patients.
Publication TypeJournal Article
Year of Publication2007
AuthorsRedwine LS, Mills PJ, Hong S, Rutledge T, Reis V, Maisel A, Irwin MR
JournalPsychosom Med
Date Published2007 Jan
KeywordsAged, Cytokines, Depression, Follow-Up Studies, Heart Failure, Humans, Immunity, Cellular, Male, Middle Aged, Morbidity, Patient Readmission, Psychiatric Status Rating Scales, Th1 Cells, Th2 Cells

OBJECTIVE: Congestive heart failure (CHF) patients with depressive symptoms have a greater risk of morbidity and mortality. Immune activity such as inflammation is increasingly implicated as underlying this relationship. However, it is unknown whether there is a broader spectrum of immune dysregulation beyond inflammatory activity. This study examined in CHF patients the relationship of depressive symptoms with cellular immune activity measured by Th1/Th2 ratios and cardiac rehospitalization and/or death.

METHOD: Eighteen patients with CHF (mean age = 62, NYHA classes II-IV) were enrolled and depressive symptoms were measured with interviewer ratings using the Hamilton Rating Scale-Depression. For the determination of Th1/Th2 ratios, intracellular cytokine expression of interferon-gamma (IFN-gamma) and interleukin-10 (IL-10) CD4+ T cells were measured by flow cytometry. Plasma interleukin-6 levels were measured to ascertain circulating inflammatory cytokine activity. Patient records were examined for cardiac related rehospitalization or cardiac related death over a two-year period after baseline depression and immune measures were taken.

RESULTS: Higher depression scores were associated with a prospective increase in incidence of cardiac related hospitalizations and/or death (p = .037). Lesser IFN-gamma/IL-10 expressing CD4+ T cell ratios were related to higher depressive symptom scores at baseline (p = .005) and a prospective increased incidence of cardiac related hospitalization or death over a two-year period (p = .05).

CONCLUSIONS: A shift in the Th1/Th2 ratio may play a role in the association between depressive symptoms and morbidity and mortality in CHF patients, suggesting broader immune dysregulation than previously considered.

Alternate JournalPsychosom Med
PubMed ID17244845