Detection of subclinical atherosclerosis and diastolic dysfunction in patients with schizophrenia

Abstract

BackgroundPatients with schizophrenia have a higher risk for cardiovascular diseases, which is associated with early mortality compared with the nonschizophrenic population. Early diagnosis of cardiovascular diseases in asymptomatic periods in patients with schizophrenia would enhance their quality of life and reduce mortality. Echocardiography, carotid ultrasonography, and ankle brachial index (ABI) measurement are known to be beneficial methods of detecting subclinical cardiovascular diseases and of risk stratification. The present study investigated carotid intima media thickness (CIMT) and ABI and echocardiographic parameters measured via conventional and tissue Doppler echocardiography in patients with schizophrenia in comparison with a control group.MethodsThe present case-control study included 116 patients with schizophrenia and 88 healthy patients. Participants with any current comorbid psychiatric disorder, current or lifetime neurological and medical problems, current coronary artery disease, diabetes, hypertension, hypothyroidism, or hyperthyroidism or who were using antihypertensives, antidiabetic agents, or antiobesity drugs were excluded. High-resolution B-mode ultrasound images were used to measure CIMT. Conventional and tissue Doppler measurements were performed according to the recommendations of the American Society of Echocardiography.ResultsLow ABI, mitral ratio of the early (E) to late (A) ventricular filling velocities, septal E′, septal S′, lateral E′, lateral S′, septal E′/septal A′, lateral E′/lateral A′, and high septal A′, mitral E/septal E′, mitral E/lateral E′, and CIMT values were observed in the schizophrenia group compared with the control group.ConclusionDoppler parameters supported the hypothesis that patients with schizophrenia are at high risk for cardiovascular diseases.

<p>The Predictive Value of Endothelial Inflammatory Markers in the Onset of Schizophrenia</p>

“…But, the echocardiographic examination showed significantly lower values of the E/A ratio in the SZ patients, suggesting the presence of subclinical left ventricular diastolic dysfunction. In a study published by Ünsal, 15 patients with SZ had decreased ABI and increased CIMT when compared to healthy controls (P<0.01). The difference in the findings could be explained by the patients′ selection.…”

“…Echocardiography, carotid ultrasonography, and anklebrachial index (ABI) measurement are known to be accurate methods of detecting subclinical atherosclerosis and risk stratification. 15 This exploratory study aimed to determine the best methods to detect the presence and progression of endothelial inflammation and subclinical atherosclerosis in antipsychotic-naïve SZ patients at first psychotic event and to determine the differences from healthy individuals, at baseline and after 6 months of antipsychotic treatment.…”

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

“…The results of our study contrast with previous cardiac imaging studies in schizophrenia. 15,16,18 Two of these studies, 15,16 using transthoracic echocardiography to quantify cardiac structure and function, have demonstrated LV hypertrophy and reduced LV ejection fraction in patients, while we observed reductions in LV mass in patients, and no difference between groups with regards right/left ejection fraction. An explanation for these contrasting outcomes may relate to the sample characteristics of the patients included in analyses.…”

“…An explanation for these contrasting outcomes may relate to the sample characteristics of the patients included in analyses. Previous studies have either failed to match patients and healthy volunteers uniformly for demographics or cardiovascular risk factors, 16, 18 or where matching for these parameters was achieved, confirmation of absence a diagnosis of diabetes mellitus in patients and controls was not confirmed with blood tests during the study. 15 This is a limitation, owing to under-reporting of physical co-morbidities in schizophrenia.…”

“…The studies that do exist have used transthoracic echocardiography (TTE) to assess cardiac function. 15–18 These have typically shown reductions in left ventricular (LV) ejection fraction in schizophrenia with large effect sizes (d = 0.92-1.17), even in the absence of cardiac symptoms or diagnosed CVD. However, to our knowledge there have been no prior studies examining for myocardial tissue alterations characteristic of a fibrotic/inflammatory process in patients taking antipsychotic drugs, or of cardiac function using MRI, the gold standard for assessing cardiac function.…”