PurposeThe heart receives high radiation doses during radiation therapy of advanced-stage lung cancer. We have explored associations between overall survival, cardiac radiation doses, and electrocardiographic (ECG) changes in patients treated in IDEAL-CRT, a trial of isotoxically escalated concurrent chemoradiation delivering tumor doses of 63 to 73 Gy.Methods and MaterialsDosimetric and survival data were analyzed for 78 patients. The whole heart, pericardium, AV node, and walls of left and right atria (LA/RA-Wall) and ventricles (LV/RV-Wall) were outlined on radiation therapy planning scans, and differential dose-volume histograms (dDVHs) were calculated. For each structure, dDVHs were approximated using the average dDVH and the 10 highest-ranked structure-specific principal components (PCs). ECGs at baseline and 6 months after radiation therapy were analyzed for 53 patients, dichotomizing patients according to presence or absence of “any ECG change” (conduction or ischemic/pericarditis-like change). All-cause death rate (DR) was analyzed from the start of treatment using Cox regression.Results38% of patients had ECG changes at 6 months. On univariable analysis, higher scores for LA-Wall-PC6, Heart-PC6, “any ECG change,” and larger planning target volume (PTV) were significantly associated with higher DR (P=.003, .009, .029, and .037, respectively). Heart-PC6 and LA-Wall-PC6 represent larger volumes of whole heart and left atrial wall receiving 63 to 69 Gy. Cardiac doses ≥63 Gy were concentrated in the LA-Wall, and consequently Heart-PC6 was highly correlated with LA-Wall-PC6. “Any ECG change,” LA-Wall-PC6 scores, and PTV size were retained in the multivariable model.ConclusionsWe found associations between higher DR and conduction or ischemic/pericarditis-like changes on ECG at 6 months, and between higher DR and higher Heart-PC6 or LA-Wall-PC6 scores, which are closely related to heart or left atrial wall volumes receiving 63 to 69 Gy in this small cohort of patients.

Mortality from cardiovascular disease is increased in people with mental health disorders in general and schizophrenia in particular. The causes are multifactorial, but it is known that antipsychotic medication can cause cardiac side-effects beyond the traditional coronary risk factors. Schizophrenia itself is a contributor to an increased risk of cardiovascular mortality via cardiac autonomic dysfunction and a higher prevalence of metabolic syndrome, both contributing to a reduced life expectancy. The pro-arrhythmic impact of traditional antipsychotics, especially via the hERG-potassium channel, has been known for several years. Newer antipsychotics have a reduced pro-arrhythmic profile but might contribute to higher cardiac death rates by worsening the metabolic profile. Clozapine-induced cardiomyopathy, which is dose independent, is a further concern and continuous monitoring of these patients is required. Prophylaxis with angiotensin-converting enzyme inhibitors is currently under review. Overall, management of cardiovascular risk within this population group must be multifaceted and nuanced to allow the most effective treatment of serious mental illness to be conducted within acceptable parameters of cardiovascular risk; some practical measures are presented for the clinical cardiologist.

BackgroundPatients with psychotic illness have increased risk of cardiovascular death. Arrhythmias [particularly Torsades de Points (TdP)] and sudden cardiac deaths (SCD) are the most serious cardiovascular consequences. There is a recognised association between TdP and QT prolongation; the latter is a known adverse effect of some psychotropic drugs. The potential contribution of ECG abnormalities other than QT prolongation has not recently been subjected to careful investigation and little is known about their prevalence and role in the increased risk of arrhythmias and SCD.AimWeaimed to determine the prevalence of ECG changes in patients with mental health disorders, currently receiving antipsychotics drugs, compared with healthy control subjects.MethodsWe conducted a prospective cross sectional study, looking at ECGs of patients on atypical antipsychotic medication, compared to ECGs of normal healthy subjects on no medication. ECGs were assessed on a blinded basis by two investigators. Detailed clinical characteristics of each subject were recorded, including age, sex, ECG variables and drug history. ECGs of patients known to have underlying cardiac disease or on cardio-active drugs were excluded from the analysis. QT was automatically corrected using the Bazett formula, with an upper limits of normal set at 440 ms for males, and 460 ms for females. Abnormalities recorded for this study included: sinus bradycardia (<55 beats/min, bpm) tachycardia (>100 bpm); conduction and axis abnormalities; Cornell or Sokolov voltage criteria for left or right ventricular hypertrophy; ST/T wave changes; and QTc prolongation. While not formally an abnormality, we also recorded the prevalence of early repolarisation.ResultsECGs of 131 patients (110 male, age 44 ± 10 years, mean±SD) and 70 normal volunteers (52 male, 47 ± 11 years, p=NS vs patients) were included in the analysis. While heart rate was a significant discriminator [81 ± 16 bpm in patients vs 67 ± 11 in matched controls, p < 0.001], QTc was comparable (412 ± 20 vs 408 ± 22, p=NS). When the cumulative prevalence of ECG abnormalities was computed, this was 33.5% for patients vs 20% for controls, (p = 0.04). Early repolarisation was found in 19% of patients vs 8.5% in the controls (p < 0.05). Detailed results are in the Table 1.Abstract 64 Table 1ECGs findings of 131 patients on anti-psychoticsType of abnormalityPatients (%)Controls (%)ST/T changes23 (17.5%)1 (1.4%)Sinus tachycardia17 (12.9%)0Conduction and axis abnormalities9 (6.8%)6 (8.5%)Sinus bradycardia8 (6.1%)7 (10%)Voltage criteria for LVH/RVH5 (3.8%)1 (1.4%)Prolonged QTc4 (3%)1 (1.4%)ConclusionCurrent use of antipsychotics drugs was associated with a trend towards an excess of a number of ECG abnormalities, especially sinus tachycardia. In contrast, QT prolongation did not differ between patients and controls and therefore does not appear likely to be of predictive value for poor cardiovascular outcomes. The higher prevalence of early repolarisation in patients may be of significance. Large scale prospective ...

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