Depressive state on cardiac remodeling and left ventricular function in chronic heart failure: A retrospective study

Table 1 Baseline characteristics analysis

Characteristic	Depressed group (n = 124)	Non-depressed group (n = 124)	P value
Mean age (years)	52.3 ± 8.7	51.6 ± 9.1	0.672
Gender (male/female)	77/47 (62.4%)	76/48 (60.8%)	0.705
NYHA classification, n (%)			0.768
NYHA II	53 (42.5)	55 (44.3)
NYHA III	71 (57.5)	69 (55.7)
Disease duration (years)	6.2 ± 3.4	5.9 ± 3.2	0.456
Comorbidities, n (%)
Hypertension	72 (58.1)	69 (55.6)	> 0.05
Diabetes	53 (42.7)	50 (40.3)	> 0.05
Dyslipidemia	59 (47.6)	56 (45.2)	> 0.05
Medication usage, n (%)
ACEI/ARB	89 (71.8)	87 (70.2)	> 0.05
Beta-Blockers	85 (68.5)	83 (66.9)	> 0.05
Diuretics	92 (74.2)	90 (72.6)	> 0.05
Lifestyle factors, n (%)
Smoking history	48 (38.7)	45 (36.3)	> 0.05
Alcohol consumption	32 (25.8)	30 (24.2)	> 0.05

Table 2 Significant changes in cardiac structure and function

Indicator	Depressed group (n = 124)	Non-depressed group (n = 124)	P value
Left ventricular ejection fraction (%)	42.3 ± 6.7	51.6 ± 5.9	< 0.01
Left ventricular end-diastolic diameter (mm)	68.2 ± 7.5	59.6 ± 6.3	< 0.01
Left ventricular end-systolic diameter (mm)	52.1 ± 6.8	43.2 ± 5.4	< 0.01
Left atrial diameter (mm)	45.3 ± 5.2	38.7 ± 4.6	< 0.01
Right ventricular systolic pressure (mmHg)	42.5 ± 7.6	35.2 ± 6.3	< 0.01
Cardiac output (L/min)	3.8 ± 0.7	4.5 ± 0.6	< 0.01
Cardiac index (L/min/m²)	2.7 ± 0.5	3.2 ± 0.4	< 0.01
Stroke volume (mL)	65.2 ± 8.3	78.4 ± 7.1	< 0.01
E/A ratio	0.8 ± 0.2	1.2 ± 0.3	< 0.01

Table 3 Myocardial fibrosis and inflammatory response

Indicator	Depressed group (n = 124)	Non-depressed group (n = 124)	P value
Myocardial fibrosis area (%)	15.6 ± 3.4	8.7 ± 2.6	< 0.01
High-sensitivity C-reactive protein (mg/L)	8.7 ± 2.3	4.5 ± 1.6	< 0.01
Tumor necrosis factor-α (pg/mL)	42.5 ± 7.6	28.3 ± 5.4	< 0.01
Neutrophil-to-lymphocyte ratio	3.2 ± 0.8	2.1 ± 0.6	< 0.01
Systemic immune-inflammation index	950 ± 150	750 ± 120	< 0.01
Systemic inflammatory response index	1.8 ± 0.4	1.2 ± 0.3	< 0.01
Inflammatory prognostic index	2.5 ± 0.6	1.5 ± 0.4	< 0.01
Transforming growth factor-β1 (ng/mL)	12.4 ± 2.3	8.9 ± 1.8	< 0.01
Interleukin-6 (pg/mL)	34.2 ± 5.8	22.1 ± 4.7	< 0.01

Table 4 Neuroendocrine and oxidative stress

Indicator	Depressed group (n = 124)	Non-depressed group (n = 124)	P value
B-Type natriuretic peptide (pg/mL)	1256 ± 345	756 ± 234	< 0.01
Angiotensin II (ng/mL)	86.4 ± 15.7	62.5 ± 12.3	< 0.01
Malondialdehyde (nmol/mL)	6.7 ± 1.4	4.2 ± 1.1	< 0.01
Superoxide dismutase (U/mL)	112.3 ± 22.7	156.4 ± 26.5	< 0.01
Cortisol (μg/dL)	18.2 ± 3.5	14.5 ± 2.8	< 0.01
Epinephrine (pg/mL)	120.4 ± 25.3	85.7 ± 18.1	< 0.01
Norepinephrine (pg/mL)	150.2 ± 30.4	100.5 ± 20.2	< 0.01
ACTH (pg/mL)	45.6 ± 8.7	32.4 ± 6.5	< 0.01
DHEA (ng/mL)	7.8 ± 1.5	10.2 ± 2.0	< 0.01

Table 5 Cell apoptosis and myocardial cell survival

Indicator	Depressed group (n = 124)	Non-depressed group (n = 124)	P value
Caspase-3 Activity (U/L)	2.7 ± 0.6	1.4 ± 0.3	< 0.01
B-cell lymphoma-2 protein expression	0.45 ± 0.12	0.78 ± 0.15	< 0.01
TUNEL positive cells (%)	25.4 ± 4.5	12.3 ± 3.2	< 0.01
Fas protein expression	1.8 ± 0.4	0.9 ± 0.3	< 0.01
FasL protein expression	2.1 ± 0.5	1.1 ± 0.4	< 0.01
MicroRNA-182-5p (miR-182-5p) Expression	1.5 ± 0.3	0.7 ± 0.2	< 0.01
Myeloperoxidase activity (U/g)	120.3 ± 25.4	85.6 ± 18.2	< 0.01
Lactate dehydrogenase release (U/L)	320.5 ± 45.2	210.4 ± 35.1	< 0.01

Table 6 Autonomic nervous system changes

Indicator	Depressed group (n = 124)	Non-depressed group (n = 124)	P value
Low-frequency component (ms²)	52.3 ± 10.6	78.5 ± 12.4	< 0.01
High-frequency component (ms²)	28.7 ± 6.5	45.2 ± 8.7	< 0.01
LF/HF ratio	1.8 ± 0.4	1.2 ± 0.3	< 0.01
Standard deviation of R-R interval (ms)	85.4 ± 15.2	105.6 ± 18.3	< 0.01
Root mean square of the difference of adjacent R-R interval (ms)	25.1 ± 5.4	35.2 ± 6.7	< 0.01
Percentage of pairs of R-R intervals with > 50 ms difference (%)	12.3 ± 3.2	22.4 ± 4.5	< 0.01
Heart rate (beats/min)	82.3 ± 10.4	75.6 ± 9.2	< 0.01
Pre-ejection period (ms)	120.4 ± 15.3	105.7 ± 12.6	< 0.01
Cardiac sympathetic nerve activity (AU)	45.6 ± 8.7	32.4 ± 6.5	< 0.01

LF: Low-frequency; HF: High-frequency.

Table 7 Psychological assessment results

Indicator	Depressed group (n = 124)	Non-depressed group (n = 124)	P value
Hamilton depression scale	21.5 ± 3.7	6.2 ± 1.9	< 0.01
Hospital anxiety and depression scale	15.3 ± 2.6	4.7 ± 1.5	< 0.01
Beck depression inventory	23.4 ± 4.5	7.8 ± 2.3	< 0.01
State-trait anxiety inventory	45.6 ± 6.7	32.4 ± 5.6	< 0.01
Perceived stress scale	28.7 ± 5.4	14.2 ± 3.1	< 0.01
Pittsburgh sleep quality index	10.2 ± 2.3	5.1 ± 1.6	< 0.01
Quality of life inventory	52.3 ± 8.7	78.5 ± 10.6	< 0.01
Social support rating scale	32.4 ± 5.6	45.6 ± 6.7	< 0.01

Table 8 Multivariate analysis and risk assessment

Factor	Adjusted risk ratio	95% confidence interval	P value
Depression	1.76	1.45-2.12	< 0.001
Inflammatory response activation	1.52	1.23-1.88	< 0.001
Neuroendocrine regulation abnormalities	1.65	1.37-2.00	< 0.001
Increased oxidative stress	1.48	1.20-1.83	< 0.001
Disrupted cell apoptosis programs	1.70	1.40-2.05	< 0.001
Autonomic nervous system imbalance	1.60	1.32-1.93	< 0.001
Poor sleep quality	1.45	1.18-1.78	< 0.001
Inflammatory response activation	1.52	1.23-1.88	< 0.001
Low social support	1.55	1.27-1.89	< 0.001