BNP and Neuroimmune Characteristics of CHF & Depression

7.项目摘要/摘要 心力衰竭(HF)是一个主要的公共卫生问题，影响着超过550万美国人，超过 每年新增确诊病例55万例，占所有入院人数的10%。抑郁症 是对有症状的患者的发病率和过早死亡率最可靠的行为预测因子 心力衰竭，根据心力衰竭的严重程度，发病率从20%到45%不等。我们正在进行的HL-073355项目是 检查与心力衰竭患者抑郁相关的病理生理学。很少有研究系统地 检查了抑郁症的发展和进展与发展和进展的同时 与症状性心衰及其相关的神经免疫和行为机制有关。通过在以下地址注册个人 罹患有症状心衰的风险，但目前无症状，即美国大学 心脏病/美国心脏协会B期患者，这是HL-073355的竞争性更新 将前瞻性地跟踪抑郁症状和严重抑郁障碍的发生率和时间进程 (MDD)，症状性心力衰竭的发展，潜在的神经免疫和行为机制联系心力衰竭 和MDD，以及与心血管临床结果的关联。我们将招收522名高风险(定义为BNP) 100pg/ml)ACC/AHA B期患者，在服药时进行研究，每6个月平均30例 月份。通过我们与加州大学圣地亚哥分校HF团队的密切合作 (UCSD)Hillcrest和La Jolla医疗中心，以及圣地亚哥退伍军人事务部医疗系统 (VASDHS)在拉荷亚，我们可以接触到大量无症状的B期患者。临床 评估将包括超声心动图和Beck对抑郁症状的表征 抑郁量表(BDI)和DSM障碍结构化临床访谈(SCID)。神经免疫 评估将包括循环BNP、CRP、TNF-β、IL-1、IL-6、sICAM-1、sP-选择素、 儿茶酚胺和白细胞功能评估。除抑郁外，其他行为和行为障碍 心理社会评估将包括睡眠、健康行为(例如吸烟、体育活动)、 心理社会压力源、应对、焦虑、社交网络和生活质量。临床结果将包括 从无症状心功能不全过渡到有症状的C和/或D心衰阶段，临床心血管 结果(因心血管事件和/或死亡而住院的综合情况)，以及 MDD复发。这项前瞻性研究的发现有可能为MDD是如何 可能在疾病的早期阶段导致心力衰竭的进展。更好地理解角色和 MDD在此阶段可能影响心衰的机制可能支持临床相关的早期MDD 在有效的抑郁症治疗可能对 心衰的病程。

7. PROJECT SUMMARY/ABSTRACT Heart failure (HF) is a major public health concern, affecting more than 5.5 million Americans, with over 550,000 new cases diagnosed each year, and accounting for up to 10% of all hospital admissions. Depression is the most robust behavioral predictor of morbidity and premature mortality among patients with symptomatic HF, with an incidence ranging from 20% to 45%, depending on HF severity. Our ongoing project HL-073355 is examining the pathophysiology associated with depression in HF patients. Few studies have systematically examined the development and progression of depression concurrent with the development of and progression to symptomatic HF and its associated neuroimmune and behavioral mechanisms. By enrolling individuals at risk for developing symptomatic HF but who are currently asymptomatic, namely American College of Cardiology/American Heart Association (ACC/AHA) Stage B patients, this competing renewal of HL-073355 will prospectively track the incidence and time course of depressive symptoms and Major Depressive Disorder (MDD), the development of symptomatic HF, potential neuroimmune and behavioral mechanisms linking HF and MDD, and associations with cardiovascular clinical outcomes. We will enroll 522 high-risk (defined as BNP >100pg/ml) ACC/AHA Stage B patients, study them at intake, and every 6 months for an average of 30 months. Through our strong collaborations with the HF teams at the University of California, San Diego (UCSD) Hillcrest and La Jolla Medical Centers, and the Veterans Affairs San Diego Healthcare System (VASDHS) in La Jolla, we have access to a large number of asymptomatic Stage B patients. Clinical assessments will include echocardiography and characterization of depressive symptoms by the Beck Depression Inventory (BDI) and the Structured Clinical Interview for DSM Disorders (SCID). Neuroimmune assessments will include circulating levels of BNP, CRP, TNF-¿, IL-1¿, IL-6, sICAM-1, sP-selectin, catecholamines, and functional assessments of leukocytes. In addition to depression, other behavioral and psychosocial assessments will include sleep, health behaviors (e.g., smoking, physical activity), psychosocial stressors, coping, anxiety, social network, and quality of life. Clinical outcomes will include transition from asymptomatic cardiac dysfunction to symptomatic Stages C and/or D HF, clinical cardiovascular outcomes (combined hospitalizations for cardiovascular events and/or death), and the development or recurrence of MDD. Findings from this prospective study have the potential to add new insights into how MDD might contribute to HF progression at early stages of the disease. A greater understanding of the role and mechanisms by which MDD may impact HF at this stage could support clinically relevant early MDD intervention efforts at a point when effective depression treatment could have a potentially greater impact on the course of HF.