Cardiac structure and function in patients with schizophrenia taking antipsychotic drugs: an MRI study

Abstract

Cardiovascular disease (CVD) is a major cause of excess mortality in schizophrenia. Preclinical evidence shows antipsychotics can cause myocardial fibrosis and myocardial inflammation in murine models, but it is not known if this is the case in patients. We therefore set out to determine if there is evidence of cardiac fibrosis and/or inflammation using cardiac MRI in medicated patients with schizophrenia compared with matched healthy controls. Thirty-one participants (14 patients and 17 controls) underwent cardiac MRI assessing myocardial markers of fibrosis/inflammation, indexed by native myocardial T1 time, and cardiac structure (left ventricular (LV) mass) and function (left/right ventricular end-diastolic and end-systolic volumes, stroke volumes, and ejection fractions). Participants were physically fit, and matched for age, gender, smoking, blood pressure, BMI, HbA1c, ethnicity, and physical activity. Compared with controls, native myocardial T1 was significantly longer in patients with schizophrenia (effect size, d = 0.89; p = 0.02). Patients had significantly lower LV mass, and lower left/right ventricular end-diastolic and stroke volumes (effect sizes, d = 0.86–1.08; all p -values < 0.05). There were no significant differences in left/right end-systolic volumes and ejection fractions between groups ( p > 0.05). These results suggest an early diffuse fibro-inflammatory myocardial process in patients that is independent of established CVD-risk factors and could contribute to the excess cardiovascular mortality associated with schizophrenia. Future studies are required to determine if this is due to antipsychotic treatment or is intrinsic to schizophrenia.

Cardiac structure and function in schizophrenia: cardiac magnetic resonance imaging study

“…We previously found evidence suggesting that an early diffuse myocardial fibrosis and/or subclinical myocardial inflammation are present in the hearts of people with schizophrenia. 43 This would suggest that concentric heart remodelling and cardiac fibro-inflammatory changes could both be driven by systemic inflammation, leading to pro-fibrotic stimuli and hence cardiac remodelling with deposition of collagen. In support of this theory, there are established cross-sectional associations between schizophrenia and elevations in peripheral pro-inflammatory cytokines, including interleukin-6 (IL-6) and transforming growth factor β (TGF-β).…”

Cardiac structure and function in schizophrenia: a cardiac MR imaging study

“…Schizophrenia has been associated with elevations in peripheral pro-inflammatory cytokines, including in interleukin-6 (IL-6) and tumour necrosis factor levels in antipsychotic-naïve individuals(37). IL-6 and related cytokines play a crucial role in the regulation of cardiac myocyte hypertrophy and apoptosis(38), and initial evidence supports an early diffuse fibro-inflammatory myocardial process in patients with schizophrenia(39).…”

Homocysteine level, body mass index and clinical correlates in Chinese Han patients with schizophrenia

“…Schizophrenia is a severe psychiatric disorder characterized by chronic progressive impairments of physical, cognitive and psychosocial function. Weight gain is common in schizophrenia, which is a risk factor for some chronic diseases, such as diabetes, hypertension, and cardiovascular disease [1][2][3][4] . In addition, obesity leads to a lower quality of life and 10 ~ 20 years of shorter life expectancy in schizophrenia 5 .…”