BackgroundDepressive symptoms are associated with heightened risk of heart failure (HF), but their association with cardiac function and with HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF) in late life is unclear. We aimed to determine the prevalence of depression in HFpEF and in HFrEF in late life, and the association of depressive symptoms with cardiac function and incident HFpEF and HFrEF.Methods and ResultsWe studied 6025 participants (age, 75.3±5.1 years; 59% women; 20% Black race) in the ARIC (Atherosclerosis Risk in Communities) study at visit 5 who underwent echocardiography and completed the Center for Epidemiologic Studies Depression Scale questionnaire. Among HF‐free participants (n=5086), associations of Center for Epidemiologic Studies Depression Scale score with echocardiography and incident adjudicated HFpEF and HFrEF were assessed using multivariable linear and Cox proportional hazards regression. Prevalent HFpEF, but not HFrEF, was associated with a higher prevalence of depression compared with HF‐free participants (P<0.001 and P=0.59, respectively). Among HF‐free participants, Center for Epidemiologic Studies Depression Scale score was not associated with cardiac structure and function after adjusting for demographics and comorbidities (all P>0.05). Over 5.5‐year follow‐up, higher Center for Epidemiologic Studies Depression Scale score was associated with heightened risk of incident HFpEF (hazard ratio [HR] [95% CI], 1.06 [1.04–1.12]; P=0.02), but not HFrEF (HR [95% CI], 1.02 [0.96–1.08]; P=0.54), independent of echocardiographic measures, NT‐proBNP (N‐terminal pro‐B‐type natriuretic peptide), troponin, and hs‐CRP (high‐sensitivity C‐reactive protein) (HR [95% CI], 1.06 [1.00–1.12]; P=0.04).ConclusionsWorse depressive symptoms predict incident HFpEF in late life, independent of common comorbidities, cardiac structure and function, and prognostic biomarkers. Further studies are necessary to understand the mechanisms linking depression to risk of HFpEF.

中文翻译：

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抑郁症状、心脏结构和功能以及射血分数保留的心力衰竭和晚年射血分数降低的心力衰竭的发生风险


背景抑郁症状与心力衰竭 (HF) 风险增加相关，但其与晚年心功能、射血分数保留型心力衰竭 (HFpEF) 和射血分数降低型心力衰竭 (HFrEF) 的关系尚不清楚。我们的目的是确定晚年 HFpEF 和 HFrEF 中抑郁症的患病率，以及抑郁症状与心功能和 HFpEF 和 HFrEF 事件的关系。方法和结果我们研究了 6025 名参与者（年龄，75.3±5.1 岁；59% 为女性；59% 为女性；59% 为女性；59% 为女性）。 20% 黑人种族）在 ARIC（社区动脉粥样硬化风险）研究中的第 5 次访视中接受了超声心动图检查并完成了流行病学研究中心抑郁量表问卷。在无 HF 的参与者 (n=5086) 中，使用多变量线性和 Cox 比例风险回归评估流行病学研究中心抑郁量表评分与超声心动图以及事件判定的 HFpEF 和 HFrEF 的关联。与无 HF 的参与者相比，流行的 HFpEF（而非 HFrEF）与较高的抑郁症患病率相关（分别为P <0.001 和P =0.59）。在无心力衰竭的参与者中，流行病学研究中心抑郁量表评分在调整人口统计和合并症后与心脏结构和功能无关（所有P >0.05）。经过 5.5 年的随访，流行病学研究中心抑郁量表评分较高与 HFpEF 事件风险升高相关（风险比 [HR] [95% CI]，1.06 [1.04–1.12]； P = 0.02），但并非如此HFrEF（HR [95% CI]，1.02 [0.96–1.08]； P = 0。54)，独立于超声心动图测量、NT-proBNP（N 端 B 型利钠肽原）、肌钙蛋白和 hs-CRP（高敏 C 反应蛋白）（HR [95% CI]，1.06 [1.00 –1.12]； P = 0.04）。结论 更严重的抑郁症状可预测晚年发生的 HFpEF，与常见合并症、心脏结构和功能以及预后生物标志物无关。需要进一步的研究来了解抑郁症与 HFpEF 风险之间的联系机制。