Echocardiographic study of cardiac structure and function in people with bipolar disorder after midlife

Chen, Pao‐Huan; Chiang, Shuo-Ju; Hsiao, Cheng-Yi; Shen, Ruei-Siang; Lin, Yen‐Kuang; Chung, Kuo Hsuan; Tsai, Shang‐Ying

doi:10.1016/j.jad.2021.09.089

Cited by 8 publications

(7 citation statements)

References 40 publications

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“…In contrast to prior echocardiography and CMR studies in adults, which have found that depression, schizophrenia, and BD are associated with poorer measures of LV function and structure (Andreou et al, 2020;Chen et al, 2021;Chen & Chung, 2018;Kim et al, 2012;Korkmaz, Korkmaz, Özer, & Atmaca, 2016;Pillinger et al, 2019), there were no significant differences in LV volumes or mass between youth with BD and controls. However, this could be expected, given that this is an otherwise healthy youth sample with a relatively short duration of illness.…”

Section: Left Ventricular Parameters In Youthcontrasting

confidence: 85%

Impaired coronary microvascular reactivity in youth with bipolar disorder

Kennedy,

Ghugre,

Roifman

et al. 2023

Psychol. Med.

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Background Cardiovascular disease (CVD) is excessively prevalent and premature in bipolar disorder (BD), even after controlling for traditional cardiovascular risk factors. The increased risk of CVD in BD may be subserved by microvascular dysfunction. We examined coronary microvascular function in relation to youth BD. Methods Participants were 86 youth, ages 13–20 years (n = 39 BD, n = 47 controls). Coronary microvascular reactivity (CMVR) was assessed using quantitative T2 magnetic resonance imaging during a validated breathing-paradigm. Quantitative T2 maps were acquired at baseline, following 60-s of hyperventilation, and every 10-s thereafter during a 40-s breath-hold. Left ventricular structure and function were evaluated based on 12–15 short- and long-axis cardiac-gated cine images. A linear mixed-effects model that controlled for age, sex, and body mass index assessed for between-group differences in CMVR (time-by-group interaction). Results The breathing-paradigm induced a significant time-related increase in T2 relaxation time for all participants (i.e. CMVR; β = 0.36, p < 0.001). CMVR was significantly lower in BD v. controls (β = −0.11, p = 0.002). Post-hoc analyses found lower T2 relaxation time in BD youth after 20-, 30-, and 40 s of breath-holding (d = 0.48, d = 0.72, d = 0.91, respectively; all pFDR < 0.01). Gross left ventricular structure and function (e.g. mass, ejection fraction) were within normal ranges and did not differ between groups. Conclusion Youth with BD showed evidence of subclinically impaired coronary microvascular function, despite normal gross cardiac structure and function. These results converge with prior findings in adults with major depressive disorder and post-traumatic stress disorder. Future studies integrating larger samples, prospective follow-up, and blood-based biomarkers are warranted.

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Section: Left Ventricular Parameters In Youthcontrasting

confidence: 85%

Impaired coronary microvascular reactivity in youth with bipolar disorder

Kennedy,

Ghugre,

Roifman

et al. 2023

Psychol. Med.

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“…Policymakers may consider guidelines for regular cardiac evaluations in patients with bipolar disorder, especially during the manic phases. [17] The implications of these findings are multiple. Clinically, they underscore the need for a more holistic approach to managing bipolar disorder, where cardiac monitoring, particularly echocardiographic evaluation of myocardial strain, becomes an integral part of the treatment and management strategy.…”

Section: Discussionmentioning

confidence: 99%

“…Policymakers may consider guidelines for regular cardiac evaluations in patients with bipolar disorder, especially during the manic phases. [ 17 ]…”

Section: Discussionmentioning

confidence: 99%

Echocardiographic evaluation of myocardial strain in bipolar disorder across different phases: A comparative study with healthy controls

Duz

2024

Medicine

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This study aims to investigate the relationship between different phases of bipolar disorder (depressive, manic, and euthymic) and myocardial deformation, assessed by echocardiography, compared to healthy controls. It seeks to elucidate whether these phases of bipolar disorder are associated with different myocardial strain patterns, thus contributing to the understanding of cardiovascular implications in bipolar disorder. A cross-sectional design was employed at Dursun Odabaş Medical Centre, Psychiatry Clinic of Van Yüzüncü Yl University. The study enrolled 200 participants, divided into 4 groups: 50 in a depressive phase, 50 in a manic phase, 50 in an euthymic phase of bipolar disorder, and 50 healthy volunteers. Participants underwent detailed electrocardiographic and ECG evaluations, focusing on myocardial strain patterns and cardiac function. Statistical analyses, including ANOVA and chi-square tests, were used to compare the groups. Significant differences in global longitudinal strain (GLS) values were observed between the groups. The manic phase group exhibited the highest GLS (21.51), followed by the euthymic (20.75), depressive (20.25), and healthy control groups (19.0). The E/A ratio of the mitral valve also varied, with the manic group displaying the highest ratio (1.21). Other echocardiographic parameters such as left atria size and Ejection Fraction also differed significantly between the groups. The study concluded that the phases of bipolar disorder are associated with distinct myocardial strain patterns, as evidenced by the variation in GLS values. The findings underscore the importance of cardiac monitoring in bipolar disorder, suggesting potential cardiac risks, particularly during the manic phase. This study advocates integrated care approaches, combining psychiatric and cardiac evaluations for patients with bipolar disorder.

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“…Echocardiography was performed by an experienced board‐certified cardiologist blinded to the clinical data according to our previously published protocol 4,6 . In brief, LV geometric patterns were determined based on the recommendations from the American Society of Echocardiography 7 .…”

Section: Variables With Lithium Treatment (N = 58) Without Lithium Tr...mentioning

confidence: 99%

Association of Lithium Treatment With Reduced Left Ventricular Concentricity in Patients With Bipolar Disorder

Chen

Hsiao

Chiang

et al. 2022

Psychiatry Clin Neurosci

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condition remained stable. At the time of this study, she was being treated with risperidone (1 mg/day). She mainly manifested negative symptoms, including social withdrawal and apathy. Brain CT revealed no significant findings. She showed abnormal electroencephalogram patterns during sleep involving slow-wave burst-firing lasting several seconds, predominantly over the bilateral frontal and central regions.Here, we provide the first report of clinical manifestations of SCZ in patients with variants in VGCC genes. The de novo or rare variants affected SCZ-associated genes, supporting their pathogenicity. CACNA1C deletion, which reduces gene expression and has a loss-of-function effect, was identified in patient 1 with severe cognitive impairment and treatment resistance. Interestingly, similar phenotypes have been reported in individuals carrying larger deletions involving CACNA1C and other genes (Supplementary D1). Mice with conditional-knockout of Cacna1c in forebrain glutamatergic neurons have exhibited cognitive impairments and other SCZ-related behavioral abnormalities. 9 Therefore, dysfunction in glutamatergic synapses may underlie the cognitive impairments and psychoses in patient 1. Conversely, CACNA1C p.A36V, which has a gain-offunction effect on VGCC and impairs neuronal Ca 2+ homeostasis, 8 was identified in patient 2, along with autistic traits. Gain-of-function variants in CACNA1C can lead to Timothy syndrome, which is characterized by autism (Supplementary D2). Patients 3 and 4 had neurological traits associated with VGCC dysfunction, including tremor and hearing loss. 10 However, the deletions they carry also affect genes other than VGCC genes (Supplementary D3). Identification of de novo VGCC genetic variants supports a role for VGCC genes in the pathophysiology of SCZ while various clinical manifestations suggest phenotypic heterogeneity.

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Echocardiographic study of cardiac structure and function in people with bipolar disorder after midlife

Cited by 8 publications

References 40 publications

Impaired coronary microvascular reactivity in youth with bipolar disorder

Impaired coronary microvascular reactivity in youth with bipolar disorder

Echocardiographic evaluation of myocardial strain in bipolar disorder across different phases: A comparative study with healthy controls

Association of Lithium Treatment With Reduced Left Ventricular Concentricity in Patients With Bipolar Disorder

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