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European Heart Journal Advance Access published online on September 5, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi480
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European Heart Journal © The European Society of Cardiology 2005; all rights reserved
Received February 12, 2005
Revised August 3, 2005
Accepted August 11, 2005

Clinical research

Relationship between left ventricular dysfunction and depression following myocardial infarction: data from the MIND-IT

Joost P. van Melle 1*, Peter de Jonge 2, Johan Ormel 3, Harry JGM Crijns 4, Dirk J van Veldhuisen 1, Adriaan Honig 5, Aart H. Schene 6, Maarten P van den Berg 1, and for the MIND-IT investigators

1 Department of Cardiology, Thorax Centre, University Medical Centre Groningen, PO Box 30.001, 9700 RB, The Netherlands
2 Department of Internal Medicine and Psychiatry, University Medical Centre Groningen, The Netherlands
3 Department of Psychiatry, University Medical Centre Groningen, The Netherlands
4 Department of Cardiology, University Hospital Maastricht, The Netherlands
5 Department of Psychiatry, St Lucas Andreas Hospital, Amsterdam, The Netherlands
6 Department of Psychiatry, Academic Medical Centre, Amsterdam, The Netherlands

* To whom correspondence should be addressed.
Joost P. van Melle, E-mail: j.p.van.melle{at}med.umcg.nl


  Abstract

Aims Depression in patients following myocardial infarction (MI) is associated with an increased risk of mortality, but this association may be confounded by cardiac disease severity. We explored the relationship between left ventricular ejection fraction (LVEF) and depression in MI patients.

Methods and results In the Myocardial Infarction and Depression--Intervention Trial (MIND-IT), 1989 MI patients were assessed for depressive symptoms [Beck Depression Inventory (BDI) t = 0, 3, 6, 9, and 12 months post-MI]. Patients with BDI score ≥10 were assessed for the presence of International Classification of Diseases, 10th revision (ICD-10) depressive disorder (t = 3, 6, 9, and 12 months post-MI). Patients were divided into categories according to their LVEF during hospitalization, i.e. LVEF <30%, LVEF 30-45%, LVEF 45-60%, and LVEF ≥60%. During hospitalization, presence of depressive symptoms was higher in patients with LV dysfunction. A relationship was found between LVEF and ICD-10 depressive disorder, i.e. a lower LVEF was associated with a higher rate of depression from 3-12 months post-MI (P < 0.01). Levels of LVEF inversely correlated with the BDI score at 3 months post-MI. Associations persisted after adjustment for demographics, risk factors for coronary artery disease, co-morbidity, Killip class, and baseline BDI score.

Conclusion In MI patients, the rate of depression and the severity of depressive symptoms are significantly related to the severity of LV dysfunction. The association between depression and LV dysfunction must be acknowledged when evaluating the prognostic effects of depression in cardiac patients.

Keywords: Left ventricular ejection fraction; Myocardial infarction; Depression; Risk factors.
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