P5467Treatment of severe aortic stenosis by transcatheter aortic valve replacement (TAVR) is associated with a decrease of pre-existing depression and anxiety

Abstract

Background and aims: In patients suffering from cardiovascular disorders, especially in heart failure patients, depression negatively affects the clinical course concerning both, symptom tolerance as well as definite clinical endpoints. For patients undergoing Transcatheter Aortic Valve Replacement (TAVR), a detailed analysis of depression using established and specific questionnaires has not been performed to date. Method(s): Between August 2016 and November 2017, 130 of 177 patients who underwent transfemoral TAVR at our institution were enrolled in this study. Besides classical clinical parameters including six minute walk test and brain natriuretic peptide (BNP), health state of the patients was determined by the EuroQol questionnaire (EQ-5D), the Visual Analog Scale (VAS) and the Clinical Frailty Score (CFS). Furthermore, a more specific assessment of depression and anxiety was performed using the Hospital Anxiety and Depression Scale (HADS-D), which was especially validated in cardiovascular patients. All parameters were recorded directly before TAVR, at 6 week as well as 6-12 month (long-term) follow up. Result(s): Before TAVR, 48 patients (40%) revealed depression and/or anxiety with >=8 points in HADS (9.02+/-3.69 for depression and 9.00+/-3.37 for anxiety). In these patients, a significant decrease could be shown 6 weeks after TAVR for both parameters (7.03+/-3.96; p=0.036 for depression and 6.70+/-3.63; p=0.003 for anxiety). Moreover, BNP serum levels (pg/ml) were significantly reduced (889.93+/-2316.35 versus 503.49+/-846.71, p=0.019). In accordance, 6-minute walk distance (meter) (148.68+/-141.97 versus 281.61+/-149.67, p=0.001) as well as VAS (46.65+/-21.1 versus 55.28+/-19.05, p=0.025) was significantly increased. In contrast, there were no significant changes in all categories of the EQ-5D and the CFS. In the long-term follow up, there were no further dynamics in all parameters analyzed compared to the 6-week follow up. Irrespective of pre-existing depression and/or anxiety, the entire patients' cohort showed significant improvements regarding BNP serum levels, 6-minute walk distance, VAS and CFS (p<0.05). Conclusion(s): We found a high percentage of TAVR patients showing increased values in HADS with particular respect to depression (35 of the 48 patients). Interestingly, already 6 weeks after successful TAVR, a remarkable decrease in depression and anxiety could be detected using HADS. These effects were maintained even after 6 to 12 months. In contrast, the other established instruments measuring health state did not reflect these changes. Thus, the HADS can be suggested as a valuable and more sensitive tool to assess mental health state in TAVR patients. The reduction of both, HADS and BNP supports the hypothesis that impaired hemodynamics and consecutive neuroendocrine activation might contribute to depression development in patients with severe aortic stenosis and that the clinical improvement positively affects depression.