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首页> 外文期刊>Journal of cardiac failure >Selective serotonin reuptake inhibitors modify the effect of beta-blockers on long-term survival of patients with end-stage heart failure and major depression.
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Selective serotonin reuptake inhibitors modify the effect of beta-blockers on long-term survival of patients with end-stage heart failure and major depression.

机译：选择性5-羟色胺再摄取抑制剂可改变β受体阻滞剂对晚期心力衰竭和重度抑郁症患者长期生存的影响。

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BACKGROUND: Major depression (MD) is a key feature in heart failure (HF), and it is unclear whether common antidepressive medications interact with cardiovascular drugs used for the treatment of patients with MD and HF, affecting their efficacy. We examined the impact of MD on long-term survival of patients with end-stage severe HF. We also evaluated the interaction between antidepressive medication and beta-blockers on the clinical outcome of these patients. METHODS AND RESULTS: The study population consisted of 250 patients with end-stage severe HF. Sixty-one percent of these patients suffered MD and were receiving selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), or tricyclic antidepressants (TCA). All patients were followed prospectively for 18 months. The primary end point was cardiovascular death. At baseline, patients with severe MD had higher serum interleukin 6 (P < .05) and soluble vascular cell adhesion molecule (P < .01). During the follow-up, 167 cardiovascular deaths were reported, and MD was 1 of the major predictors of cardiovascular death (P = .031), whereas treatment with angiotensin receptor inhibitors and statins were also important negative predictors of mortality (P = .036 and P = .039, respectively). Although beta-blockers had a borderline nonsignificant effect on cardiovascular mortality in the overall population, they had a striking beneficial effect among those patients with major depression receiving SSRIs (P = .006), whereas they had a negative effect on mortality in those patients receiving SNRIs/TCAs (P = .025). CONCLUSIONS: MD is an independent predictor of cardiovascular death in patients with end-stage HF. beta-blockers are associated with lower cardiovascular mortality in patients with end-stage HF and depression only when they are combined with SSRIs.
机译：背景：重度抑郁症（MD）是心力衰竭（HF）的关键特征，目前尚不清楚常见的抗抑郁药是否与用于治疗MD和HF的心血管药物相互作用，从而影响其疗效。我们检查了MD对晚期重症HF患者长期生存的影响。我们还评估了抗抑郁药物和β受体阻滞剂之间对这些患者临床结局的相互作用。方法和结果：研究人群包括250例晚期重症心衰患者。这些患者中有61％患有MD，正在接受选择性5-羟色胺再摄取抑制剂（SSRI），5-羟色胺去甲肾上腺素再摄取抑制剂（SNRIs）或三环抗抑郁药（TCA）。所有患者均接受了18个月的前瞻性随访。主要终点是心血管死亡。在基线时，患有严重MD的患者具有较高的血清白介素6（P <.05）和可溶性血管细胞粘附分子（P <.01）。在随访期间，报告了167例心血管死亡，MD是心血管死亡的主要预测因子之一（P = .031），而使用血管紧张素受体抑制剂和他汀类药物治疗也是死亡率的重要阴性预测因子（P = .036）。和P分别为.039）。尽管β受体阻滞剂对总体人群的心血管死亡率没有临界影响，但在接受SSRI的重度抑郁患者中，它们具有显着的有益作用（P = .006），而对于接受SSRI的那些患者，它们对死亡率具有负面影响SNRIs / TCA（P = .025）。结论：MD是终末期HF患者心血管死亡的独立预测因子。仅当将SS抑制剂与SSRIs联合使用时，β受体阻滞剂才可降低晚期HF和抑郁症患者的心血管死亡率。

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