Clinical Significance of NT-proBNP as a Predictive Biomarker of Depressive Symptoms in Cardiac Patients

Syeda Humayra ¹ Noorazrul Yahya ² Chai Jia Ning ³ Mohd Asyiq Mohd Raffali ⁴ Imtiyaz Ali Mir ⁵ Abdul Latiff Mohamed ⁶ Hanani Abdul Manan ^3*

• ¹ Faculty of Medicine, National University of Malaysia, Cheras, Malaysia
• ² Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
• ³ Department of Radiology, Universiti Kebangsaan Malaysia Medical Center (UKMMC), Cheras, Malaysia
• ⁴ Hospital Chancellor Tuanku Muhriz, National University of Malaysia, Cheras, Kuala Lumpur, Malaysia
• ⁵ Department of Physiothertapy, M. Kandiah Faculty of Medicine and Health Sciences, Tunku Abdul Rahman University, Kajang, Selangor Darul Ehsan, Malaysia
• ⁶ University of Cyberjaya, Cyberjaya, Selangor Darul Ehsan, Malaysia

Introduction: Depression is a significant comorbidity linked to poor subjective and objective health outcomes in cardiac patients. The paucity of data necessitates further research to elucidate the pathophysiological connection between depression and cardiac diseases in the presence of N-terminal pro-brain natriuretic peptide (NT-proBNP). Therefore, the current systematic review investigated the clinical significance of NT-proBNP as a predictive biomarker in cardiac patients with depressive symptoms.Methods: Two researchers independently performed an extensive search of published literature from inception until April 2024 on PubMed, Web of Science, and Cochrane Llibrary in accordance with the PRISMA guidelines. From a total of 452 records, 29 articles were eligible for full-text review, whereof, data from 14 articles were systematically collated. Based on the Newcastle-Ottawa Scale (NOS) criteria, all studies earned 6-9 stars and were of good quality.Results: Among a total population of 4035, male patients were predominantly higher (n=2618, 65.0%).Approximately, 31.3% (n=1264) cardiac patients were depressed. The mean age ranged between 56-76 and 58-73 years for depressed versus non-depressed individuals respectively. More than half of the patients presented with heart failure (n=2234, 55.4%), followed by acute myocardial infarction (n=1368, 34.0%), coronary artery disease (n=674, 16.7%), and acute coronary syndrome (n=164, 4.1%).Poor ventricular function (26.1±6.8 to 37.65±12.71) and worsened NYHA class II-III functional symptoms (moderate-marked limitations) were more prevalent in depression. In addition, three studies found that age and female gender were significant risk factors in depressed patients. Significant clinical relevance was established between increased NT-proBNP and depressive symptoms in seven studies.NT-proBNP values ranged between 138 to 12000 pg/mL vs. 108 to 6000 pg/mL for depressed vs. nondepressed patients.The presence of elevated NT-proBNP in depression demonstrated adverse cardiovascular outcomes and played a crucial role in predicting the clinical prognosis. Future NT-proBNP studies with predefined follow-up period at different time intervals, and in clinically depressed patients are highly recommended.