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Wilke MR, Broschmann D, Sandek A, Wachter R, Edelmann F, Herrmann-Lingen C. Longitudinal association between N-terminal B-type natriuretic peptide, anxiety and social support in patients with HFpEF: results from the multicentre randomized controlled Aldo-DHF trial. BMC Cardiovasc Disord 2023; 23:184. [PMID: 37020188 PMCID: PMC10077758 DOI: 10.1186/s12872-023-03136-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 02/20/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND Higher plasma levels of natriuretic peptides (NPs) have been associated with reduced anxiety in experimental research and a number of patient samples. As NP levels are elevated in heart failure patients, we investigate whether this elevation is related to anxiety in patients with heart failure with preserved ejection fraction (HFpEF). METHODS Post-hoc regression and mediation analyses were conducted, using data of 422 patients with HFpEF from the randomized, placebo-controlled, double-blinded, two-armed, multicentre aldosterone in diastolic heart failure trial, testing associations and their mediators between the N-terminal B-type natriuretic peptide (NT-proBNP) and anxiety at baseline and over 12-month follow-up. Anxiety was measured by the Hospital Anxiety and Depression Scale (HADS), social support by the ENRICHD Social Support Inventory and physical functioning by the Short Form 36 Health Survey. RESULTS The mean age of the study population was 66.8 ± 7.6 years, 47.6% were male and 86.0% had NYHA class II. NT-proBNP showed a weak negative correlation with HADS anxiety scores at baseline (r = - 0.087; p = 0.092), which was significant (r = - 0.165; p = 0.028) in men but not in women. NT-proBNP also tended to predict lower anxiety at 12-months in men. On the other hand, higher anxiety at baseline was associated with lower NT-proBNP scores 12 months later (r = - 0.116; p = 0.026). All associations lost significance in multivariate regression for age, perceived social support (ESSI), physical function (SF-36) and study arm. Mediation analyses revealed that social support acts as a full mediator for the link between NT-proBNP levels and anxiety. CONCLUSION The mechanisms linking NT-proBNP to anxiety may be more complex than originally assumed. While effects of NT-proBNP on anxiety may be mediated by perceived social support, there may be an additional negative effect of anxiety on NT-proBNP. Future research should consider this possible bi-directionality of the association and assess the potential influence of gender, social support, oxytocin and vagal tone on the interaction of anxiety and natriuretic peptide levels. Trial Registration http://www.controlled-trials.com (ISRCTN94726526) on 07/11/2006. Eudra-CT-number: 2006-002,605-31.
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Affiliation(s)
- Marieke R Wilke
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Von-Siebold-Str. 5, 37075, Göttingen, Germany
| | - Daniel Broschmann
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Von-Siebold-Str. 5, 37075, Göttingen, Germany
| | - Anja Sandek
- Department of Cardiology, University Hospital Leipzig, Liebigstr. 20, Haus 4, 04103, Leipzig, Germany
- Clinic for Cardiology and Pneumology, University of Göttingen Medical Center, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Rolf Wachter
- Department of Cardiology, University Hospital Leipzig, Liebigstr. 20, Haus 4, 04103, Leipzig, Germany
- Clinic for Cardiology and Pneumology, University of Göttingen Medical Center, Robert-Koch-Straße 40, 37075, Göttingen, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Mittelallee 11, 13353, Berlin, Germany
- German Center for Cardiovascular Research, Partner Site Berlin, Robert-Rössle-Str. 10, 13125, Berlin, Germany
| | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Von-Siebold-Str. 5, 37075, Göttingen, Germany.
- German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Germany.
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Podtschaske AH, Martin J, Ulm B, Jungwirth B, Kagerbauer SM. Sex-specific issues of central and peripheral arginine-vasopressin concentrations in neurocritical care patients. BMC Neurosci 2022; 23:69. [PMID: 36434506 PMCID: PMC9700878 DOI: 10.1186/s12868-022-00757-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 11/17/2022] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Arginine-Vasopressin (AVP) is a nonapeptide that exerts multiple functions within the central nervous system and in the blood circulation that might contribute to outcome in critically ill patients. Sex differences have been found for mental and physical effects of AVP. For example, stress response and response due to hemorrhage differ between males and females, at least in animal studies. Data on humans -especially on AVP within the central nervous system (CNS)-are scarce, as cerebrospinal fluid (CSF) which is said to represent central AVP activity, has to be collected by means of invasive procedures. Here we present data on 30 neurocritical care patients where we simultaneously collected blood, CSF and saliva to analyze concentrations in the central and peripheral compartments. PATIENTS AND METHODS 30 neurocritical care patients were included (13 male, 13 postmenopausal female, 4 premenopausal female) with a median age of 60 years. CSF, plasma and saliva were obtained simultaneously once in each patient and analyzed for AVP concentrations. Correlations between the central compartment represented by CSF, and the peripheral compartment represented by plasma and saliva, were identified. Relations between AVP concentrations and serum sodium and hematocrit were also determined. RESULTS In the whole patient collective, only very weak to weak correlations could be detected between AVP plasma/CSF, plasma/saliva and CSF/saliva as well as between AVP concentrations in each of the compartments and serum sodium/hematocrit. Regarding the subgroup of postmenopausal females, a significant moderate correlation could be detected for AVP in plasma and CSF and AVP CSF and serum sodium. CONCLUSION Absolute concentrations of AVP in central and peripheral compartments did not show sex differences. However, correlations between AVP plasma and CSF and AVP CSF and serum sodium in postmenopausal females indicate differences in AVP secretion and AVP response to triggers that deserve further examination.
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Affiliation(s)
- A. H. Podtschaske
- grid.6936.a0000000123222966Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - J. Martin
- grid.6936.a0000000123222966Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - B. Ulm
- grid.6936.a0000000123222966Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany ,grid.6582.90000 0004 1936 9748Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, University of Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - B. Jungwirth
- grid.6582.90000 0004 1936 9748Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, University of Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
| | - S. M. Kagerbauer
- grid.6936.a0000000123222966Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, Technical University of Munich, Munich, Germany ,grid.6582.90000 0004 1936 9748Department of Anaesthesiology and Intensive Care Medicine, School of Medicine, University of Ulm, Albert-Einstein-Allee 23, 89081 Ulm, Germany
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Sadlonova M, Meyer T, Binder L, Wachter R, Edelmann F, Herrmann-Lingen C. Higher galectin-3 levels are independently associated with lower anxiety in patients with risk factors for heart failure. Biopsychosoc Med 2020; 14:24. [PMID: 33024450 PMCID: PMC7531142 DOI: 10.1186/s13030-020-00195-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 06/09/2020] [Indexed: 12/04/2022] Open
Abstract
Background Galectin-3 promotes the proliferation of neural progenitor cells and is engaged in cell-cell adhesion, cell-matrix interactions, and macrophage activation. In addition, in patients with heart failure this carbohydrate-binding protein is a known prognostic marker for cardiovascular mortality. However, its association with psychological variables has not been investigated so far. Methods Using data from the multicenter, observational Diast-CHF (Diagnostic Trial on Prevalence and Clinical Course of Diastolic Dysfunction and Heart Failure) trial, we studied in participants with cardiovascular risk factors (n = 1260, age 66.7 ± 8.0 years, males 51%, left ventricular ejection fraction 60.0 ± 8.1%) the relationship between serum concentrations of galectin-3 and anxiety. Galectin-3 levels were measured by means of a sandwich enzyme-linked immunosorbent assay, and anxiety was assessed using the Hospital Anxiety and Depression Scale (HADS). Results In univariate analysis, there was a weak but significant inverse correlation between galectin-3 and HADS anxiety (rho = − 0.076; p = 0.008). Linear regression models adjusted for sex, age, body-mass index, estimated glomerular filtration rate, left ventricular ejection fraction, 6-min walking distance, the 36-item Short-Form Health Survey (SF-36) subscale physical functioning, and known biomarkers for heart failure confirmed that serum galectin-3 significantly and independently predicted self-rated anxiety (B = -2.413; 95%CI = -2.413–-4.422; p = 0.019). Conclusion In patients with cardiovascular risk factors, serum concentrations of galectin-3 showed an inverse association with anxiety, which was independent of both the severity of physical impairment and established risk factors for the progression of heart failure.
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Affiliation(s)
- Monika Sadlonova
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Göttingen, Germany.,Department of Thoracic and Cardiovascular Surgery, University of Göttingen Medical Center, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Thomas Meyer
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
| | - Lutz Binder
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany.,Institute for Clinical Chemistry, University of Göttingen Medical Center, Göttingen, Germany
| | - Rolf Wachter
- German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany.,Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,Department of Cardiology, University of Leipzig Medical Center, Leipzig, Germany
| | - Frank Edelmann
- Department of Cardiology and Pneumology, University of Göttingen Medical Center, Göttingen, Germany.,Department of Internal Medicine and Cardiology, Charité University Medicine, Campus Virchow Klinikum, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.,Berlin Institute of Health (BIH), Berlin, Germany
| | - Christoph Herrmann-Lingen
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Center, Göttingen, Germany.,German Center for Cardiovascular Research (DZHK), partner site Göttingen, Göttingen, Germany
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Santana MDR, Garner DM, de Moraes YM, Mangueira LB, Alcantara GC, da Silva JRA, Raimundo RD, Oliveira FR, Valenti VE. Association Between Hospital Anxiety Depression Scale and Autonomic Recovery Following Exercise. J Clin Psychol Med Settings 2019; 27:295-304. [PMID: 31776757 DOI: 10.1007/s10880-019-09683-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The hospital anxiety depression scale (HADS) is a benchmark used to investigate possible and probable cases of psychosomatic illness. Its affiliation with autonomic recovery after exercise is unclear and, as a technique applied to evaluate cardiovascular risk. We assessed a possible link between HADS and autonomic recovery after exercise. We studied healthy subjects split into two groups: Low HADS (n = 20) and High HADS (n = 21). Subjects consented to moderate aerobic exercise on a treadmill at 60% to 65% of the maximum heart rate (HR) for 30 min. We studied HR variability (HRV) before and during 30 min after exercise. Subjects with higher HADS values presented delayed recovery of HR and root-mean square of differences between adjacent normal RR intervals (RMSSD) after submaximal exercise. RMSSD during recovery from exercise had a significant association with HADS. In summary, subjects with higher HADS presented slower vagal recovery following exercise.
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Affiliation(s)
- Milana D R Santana
- Physiological and Pharmaceutical Sciences Nucleus, School of Juazeiro do Norte, R. São Francisco, 1224 - São Miguel, Juazeiro Do Norte, CE, 63010-475, Brazil
| | - David M Garner
- Cardiorespiratory Research Group, Department of Biological and Medical Sciences, Faculty of Health and Life Sciences, Oxford Brookes University, Headington Campus, Gipsy Lane, Oxford, OX3 0BP, UK
| | - Yasmim M de Moraes
- Physiological and Pharmaceutical Sciences Nucleus, School of Juazeiro do Norte, R. São Francisco, 1224 - São Miguel, Juazeiro Do Norte, CE, 63010-475, Brazil
| | - Luana B Mangueira
- Physiological and Pharmaceutical Sciences Nucleus, School of Juazeiro do Norte, R. São Francisco, 1224 - São Miguel, Juazeiro Do Norte, CE, 63010-475, Brazil
| | - Guilherme C Alcantara
- Physiological and Pharmaceutical Sciences Nucleus, School of Juazeiro do Norte, R. São Francisco, 1224 - São Miguel, Juazeiro Do Norte, CE, 63010-475, Brazil
| | - José R A da Silva
- Physiological and Pharmaceutical Sciences Nucleus, School of Juazeiro do Norte, R. São Francisco, 1224 - São Miguel, Juazeiro Do Norte, CE, 63010-475, Brazil
| | - Rodrigo D Raimundo
- Design of Studies and Scientific Writing Laboratory, ABC School of Medicine, Av. Lauro Gomes, 2000 - Vila Sacadura Cabral, Santo André, SP, CEP: 09060-870, Brazil.
| | - Fernando R Oliveira
- Department of Epidemiology, School of Public Health, University of São Paulo, USP, Av. Dr. Arnaldo, 715 - Cerqueira César, Sao Paulo, SP, Brazil
| | - Vitor E Valenti
- Autonomic Nervous System Center, UNESP, Av. Hygino Muzzi Filho, 737, Bairro: Mirante, Marília, SP, 17.525-900, Brazil
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Kagerbauer SM, Martin J, Ulm B, Jungwirth B, Podtschaske AH. Influence of perioperative stress on central and peripheral oxytocin and arginine-vasopressin concentrations. J Neuroendocrinol 2019; 31:e12797. [PMID: 31538678 DOI: 10.1111/jne.12797] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 09/16/2019] [Accepted: 09/17/2019] [Indexed: 12/27/2022]
Abstract
Perioperative stress provides not only physical, but also psychic and emotional aspects, which may influence the hypothalamic neuropeptide system. Studies investigating the perioperative course of central neuropeptide activity are missing. Therefore, the present study aimed to determine perioperative fluctuations in central and concomitant peripheral concentrations of the hypothalamic neuropeptides oxytocin (OXT) and arginine-vasopressin (AVP), as well as their impact on perioperative anxiety and depression. Cerebrospinal fluid (CSF), blood and saliva were collected from 12 patients who underwent elective endovascular aortic repair with a routinely inserted spinal catheter. AVP and OXT concentrations were analysed at four timepoints: (i) the evening before the operation; (ii) the operation day immediately before anaesthesia induction; (iii) intraoperatively after the stent was placed; and (iv) on day 1 after the operation. Patients completed the Hospital Anxiety and Depression Scale (HADS) at timepoints 1 and 4. For CSF OXT, the present study showed a significant intraoperative decline, accompanied by a decrease in saliva. OXT blood concentrations before anaesthesia induction were higher than at the evening before the operation. OXT concentrations in CSF and saliva correlated well at timepoints 2-4. AVP concentrations in CSF, blood and saliva did not show any significant changes perioperatively. However, postoperative AVP blood concentrations showed a significant negative correlation with anxiety and depression scores according to the HADS. This pilot study demonstrates perioperative fluctuations in central OXT concentrations, which are better reflected by saliva than by blood. Further studies are required to determine whether OXT and AVP can predict postoperative post-traumatic stress disorder.
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Affiliation(s)
- Simone Maria Kagerbauer
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Jan Martin
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Bernhard Ulm
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Bettina Jungwirth
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Armin Horst Podtschaske
- Department of Anaesthesiology and Intensive Care Medicine, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
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