Synergistic improvements in mental health status and cardiopulmonary performance in patients with connective tissue disease-associated pulmonary hypertension.

BACKGROUND

Patients with pulmonary hypertension (PH) experience significant mental health burden. Nevertheless, research on the relationship between mental health and connective tissue disease (CTD)-associated PH remains limited. The objectives of this retrospective study were to evaluate the prevalence of anxiety and depression and to investigate their associations with disease conditions in CTD-PH patients.

METHODS

This study included 65 patients with CTD-PH, which was verified using right heart catheterization. These patients were followed over a period of 48 ± 12 months. Assessment of clinical parameters include 6-min walk distance, World Health Organization functional class, pulmonary function, N-terminal pro brain natriuretic peptide (NT-pro BNP), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), immunoglobulins and complements, echocardiogram, and therapeutic drug. Anxiety was evaluated with the Generalized Anxiety Disorder-7 (GAD-7) scale, while depression was assessed using the Patient Health Questionnaire-9 (PHQ-9) scale.

RESULTS

One year of systemic therapy improved the mental health disorders of patients (p = 0.000 for PHQ-9, p = 0.002 for GAD-7), cardiopulmonary function (p = 0.043 for NT-pro BNP), and immunoinflammatory status (p = 0.028 for ESR), p = 0.007 for CRP). Patients with anxiety and/or depression exhibited worse cardiac function (p = 0.003 for NT-pro BNP) than those without mental health disorders. The change in the PHQ-9 score was positively correlated with the percentage of the baseline predicted value of forced expiratory volume in 1s of predicted value (FEV1/pre), as well as with the change in Immunoglobulin G and Immunoglobulin M. PH patients with primary Sjogren's syndrome (pSS) had a higher risk of readmission or death than other groups (log-rank test: p = 0.000).

CONCLUSIONS

Patients with CTD-PH are susceptible to anxiety and depression. Systemic diagnosis and treatment can improve mental health, immunoinflammatory status, and cardiopulmonary function. Collectively, these findings provide compelling evidence for the inclusion of mental health interventions in the standard care for CTD-PH and offer valuable insights into the management of CTD-PH.