Mechanism Of Mood Status On Gastrointestinal Symptoms In Patients With Heart Failure

Background:The incidence of gastrointestinal symptoms were higher in patients with heart failure.Symptoms and various pathophysiological changes concealed by symptoms causing many adverse effects.Gastrointestinal symptoms were affectd by the mood status except for the heart function.Exploring the effect of mood status on gastrointestinal symptoms for patients with heart failure was needed.Objective:To describe the prevalence and severity of gastrointestinal symptoms and investigate the mechanism of mood status on gastrointestinal symptoms in patients with heart failure(NYHA classification ?,? and ?).Methods:210 heart failure patients were recruited from a Beijing tertiary cardiovascular disease hospital in March 2016 to February 2017 by convenience sampling.The Gastrointestinal Symptom Rating Scale(GSRS)and Profile of Mood States Short Form(POMS-SF)were used to collect data.The 24h standard deviation of R-R interval,serum cortisol and norepinephrine concentration were also measured at the same time.Results:(1)Among all the gastrointestinal symptoms,abdominal distension,increased exhaust,nausea and vomiting were at higher incidence,with the rate of 60.48%,44.76%and 44.29%respectively.The proportion of gastrointestinal symptoms severe score(1=symptoms occurred occasionally,2=symptoms duration prolonged and affected part of daily activities,3=symptoms persisted and affected all daily activities)were different in,46.19%,12.86%and 31.43 in abdominal distension;38.57%,5.71%and 0.48%in increased exhaust;37.71%,8.57%and 0.00%in nausea and vomiting.In participants with NYHA classification ?,84.21%had gastrointestinal symptoms,98.57%in classification? and 95.65%in classification ?,the differences were statistically significant(P=0.011).(2)Using NYHA classification as control variable,the regression analysis processed by SPSS 22.0 showed that the severity of gastrointestinal symptoms was influenced by mood status,NYHA classification and the interaction of these two variables(P<0.01),and the standardized regression coefficients was 0.890,0.819 and 0.939.The results of hierarchical regression showed that the severity of gastrointestinal symptoms was influenced by mood status in participants with NYHA classification ?,? and IV(P<0.01),and the standardized regression coefficients was 0.890,0.819 and 0.939.(3)Path analysis processed by AMOS 20.0 showed that the direct effect coefficient of mood status on the severity of gastrointestinal symptoms was 0.578,the indirect effect coefficient of mood status on the severity of gastrointestinal symptoms by 24h Standard Diviation of R-R Intervals,serum cortisol concentration was 0.039 and 0.06.The direct effect coefficient of NYHA classification on the severity of gastrointestinal symptoms was not statistically significant(P>0.05),the indirect effect coefficient of NYHA classification on the severity of gastrointestinal symptoms by 24h Standard Diviation of R-R Intervals was 0.023 and the total indirect effect coefficient by mood status was 0.133.The effect coefficient of mood status and heart function on the severity of gastrointestinal symptoms by serum norepinephrine concentration were not statistically significant(P>0.05).Conclusion:In this study,the effect of mood status on the severity of gastrointestinal symptoms are highest in NYHA classification ? patients,followed by NYHA classification ? and ? patients.The severity of gastrointestinal symptoms could be affected by mood status through the mediating effects of the autonomic nervous system and the hypothalamic-pituitary-adrenal cortex axis.The effect of mood status on the severity of gastrointestinal symptoms is stronger than heart function.The results of this study would help medical staffs to fully understand the influence degree of mood status and cardiac function on gastrointestinal symptoms and its mechanism in patients with heart failure.