The Association of Autonomic Dysfunction with the Relationship between Depression and Coronary Disease

自主神经功能障碍与抑郁症和冠心病之间的关系

• 批准号: 10524731
• 负责人: Anish Sanjay Shah
• 金额: $ 9.21万
• 依托单位: UNIVERSITY OF ILLINOIS AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-12-01 至 2023-12-02
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10524731
• 关键词: Address; Affect; Age; Age Years; Algorithms; Ambulatory Electrocardiography; Angina Pectoris; Arrhythmia; Autonomic Dysfunction; Autonomic Pathways; Autonomic nervous system; Autonomic nervous system disorders; Award; Biological; Biological Markers; Brain; Cardiovascular system; Catheterization; Cause of Death; Chest Pain; Clinical Trials; Collaborations; Coronary; Coronary Angiography; Coronary Arteriosclerosis; Coronary heart disease; Data; Depression screen; Disease; Disease Outcome; Disparity; Dose; Electrocardiogram; Evaluation; Functional disorder; Future; Goals; Health; Heart; Heart Abnormalities; Heart Rate; Individual; Intervention; K-Series Research Career Programs; Knowledge; Lead; Link; Measurement; Measures; Mental Depression; Mental Health; Mentors; Methods; Myocardial Ischemia; Myocardial perfusion; Nerve; Neurologic Process; Odds Ratio; Outcome; Participant; Pathology; Pathway interactions; Patient Selection; Patients; Peripheral; Pilot Projects; Population; Process; Psyche structure; Public Health; Questionnaires; Reflex action; Refractory; Research; Series; Sinoatrial Node; Stenosis; Stress; Stress Tests; TNFSF15 gene; Test Result; Testing; Time; Translating; Ventricular; Viola; Woman; Work; biobank; cardiovascular disorder epidemiology; clinical biomarkers; clinical practice; cohort; comorbid depression; comorbidity; cost; depressive symptoms; disability; effective intervention; effective therapy; flexibility; heart rate variability; heart rhythm; high risk population; improved; men; mortality; multidisciplinary; novel; prospective; response; sex; treatment strategy; treatment-resistant depression; young woman

A3. PROJECT ABSTRACT Comorbid depression and coronary artery disease (CAD) lead to a three-fold increase in cardiovascular mortality, but the mechanisms behind this pathology remain poorly understood. This is major public health issue as depression remains a leading cause of disability globally and CAD is the leading cause of death. Up to 1 of every 5 patients with CAD have comorbid depression, yet interventions from increased screening for depression and treatment through traditional methods have not shown any impact on overall outcomes. A potential mechanistic pathway for depression and CAD is dysfunction of the autonomic nervous system (ANS). Vagal nerve stimulation, for example, improves refractory depression and reduces chest pain from ischemic heart disease, suggesting that strong shared biological relationships exist. Heart rate variability (HRV) serves as an electrocardiographic biomarker of autonomic function, by measuring the sympathetic and parasympathetic outflow to the sinoatrial node of the heart. Low HRV represents autonomic dysfunction. We have shown that that a novel HRV measure, Dyx, shows promise as a predictor of abnormal myocardial perfusion, and in preliminary analysis shows a relationship with depression. We seek to explore the potential of HRV to serve as a means of investigating dysfunction of both central processes such as depression and peripheral cardiovascular reflexes as they relate to obstructive CAD. We hypothesize that low HRV will be associated with both depression and coronary artery disease in a dose-response manner, and that this relationship will be modified by age and sex. In the pilot study on this cohort, preliminary data that these associations exist. To fully characterize this association between depression, CAD, and ANS dysfunction, we will examine the changes in HRV in a cohort of 200 participants with both depression and CAD, either disease, or neither. Aim 1 will compare the depressive symptom burden with ANS dysfunction as measured by Dyx amongst other HRV measures. Aim 2 will compare the presence of obstructive CAD with ANS dysfunction as measured by Dyx. The interaction of age, sex, and time of day of HRV measurement with the findings will be considered. The proposed analyses will provide plausible evidence that the ANS dysfunction links both depression and CAD, with the long-term goal of identifying interventions that target ANS dysfunction to reduce mortality.

A3.项目摘要 共病抑郁症和冠状动脉疾病（CAD）导致心血管疾病增加三倍， 死亡率，但这种病理学背后的机制仍然知之甚少。这是主要的公共卫生 抑郁症仍然是全球残疾的主要原因，CAD是死亡的主要原因。起来 每5名CAD患者中就有1名患有共病抑郁症，但通过增加对 抑郁症和通过传统方法治疗对总体结果没有任何影响。一 抑郁症和CAD的潜在机制途径是自主神经系统（ANS）功能障碍。 例如，迷走神经刺激可以改善难治性抑郁症，减少缺血性胸痛。 心脏病，表明存在强烈的共享生物学关系。心率变异性（HRV） 作为自主神经功能的心电图生物标志物，通过测量交感神经和 副交感神经流出到心脏的窦房结。低心率变异性代表自主神经功能障碍。我们 已经表明，一种新的HRV测量，Dyx，显示出作为异常心肌的预测的前景， 灌注，并在初步分析显示与抑郁症的关系。我们致力于探索 心率变异性作为一种手段，调查功能障碍的两个中央过程，如抑郁症， 外周心血管反射，因为它们与阻塞性CAD有关。我们假设低心率变异性 与抑郁症和冠状动脉疾病以剂量反应方式相关， 年龄和性别会改变关系。在对这一队列的初步研究中，初步数据表明， 协会存在。为了充分描述抑郁症、CAD和ANS功能障碍之间的关联，我们 将检查200名抑郁症和冠心病患者的心率变异性的变化， 或者两者都不是目的1将比较抑郁症状负担与ANS功能障碍，如Dyx测量 其他HRV指标。目的2将比较阻塞性CAD与ANS功能障碍的存在， 由Dyx测量。年龄、性别和心率变异性测量的时间与结果的相互作用将是 考虑了拟议的分析将提供合理的证据，证明ANS功能障碍与这两种疾病有关。 抑郁症和CAD，长期目标是确定针对ANS功能障碍的干预措施， mortality.