JACC：左室辅助装置改善终末心衰患者的抑郁和焦虑

美国学者的一项研究表明，终末期心衰患者应用恒流式左室辅助装置（CF LVAD）治疗后可改善抑郁和焦虑评分，并可保持稳定达1年。这种改善似乎与精神科药物应用无关。相关研究在线发表于2013年3月《美国心脏病学会杂志》（J Am Coll Cardiol），同时于2013年美国心脏病学会第62届科学年会（ACC2013）公布。
CFLVAD在治疗终末期期心衰（HF）患者中的应用越来越多，经过此方法治疗的患者健康状况也有所改善，但针对这类人群的抑郁和焦虑发病率和病程进行的相关研究有限。该研究纳入了124例置入CF LVAD的患者。前瞻性评估其抑郁（PHQ9）和焦虑（GAD7）。
结果显示，完成PHQ9和GAD7的受试者分别为87例和70例（平均年龄=55 ± 15；14%为女性，81%为白种人，61%为心脏移植前的过渡支持）。41%的LVAD置入患者应用了精神科药物（除外兴奋剂和睡眠药物），40%患者进行了最终的PHQ9/GAD7管理。研究者发现LVAD置入后的平均抑郁和焦虑有明显改善（抑郁p < .0001，焦虑p = 0.004），这种状态持续稳定达1年。
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IMPACT OF CONTINUOUS FLOW LEFT VENTRICULAR ASSIST DEVICE THERAPY ON DEPRESSION AND ANXIETY
Background
Continuous-flow left ventricular assist devices (CF LVAD) are increasingly used in the therapeutic algorithm for patients with end-stage heart failure (HF). Treated patients show improvements on global health status measures. However, there has been limited investigation regarding the prevalence and course of depression and anxiety in this population.
Methods
Depression (PHQ9) and anxiety (GAD7) were assessed prospectively as part of routine clinical care in ambulatory patients with stage D HF supported with a CF LVAD presenting to the outpatient clinic at our institution.
Results
Of 124 CF LVAD patients seen between October 2009 and April 2012, 87 completed the PHQ9 and 70 of these patients also completed the GAD7 (mean age = 55 ± 15; 14% female; 81% white, 61% bridge to transplant). At LVAD implantation, 41% of patients were on psychotropic medication (excluding stimulants and sleep medication), and 40% at last PHQ9/GAD7 administration. We found a significant improvement in mean depression and anxiety following implantation (depression: 11.3 ± 7.2 to 4.7 ± 5.6, p < .0001, anxiety: 7.6 ± 6.0 to 2.7± 2.9, p = 0.004), that remained stable through one year (all pairwise mean comparisons over time were not significant (p > 0.1) (Figure).
Conclusion
Depression and anxiety scores improve after CF LVAD therapy, and remain stable up to one year. The improvement does not appear related to psychotropic medication usage and is likely related to improved health