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

Abstract

Background Heart disease is the leading cause of death in schizophrenia. However, there has been little research directly examining cardiac function in schizophrenia. Aims To investigate cardiac structure and function in individuals with schizophrenia using cardiac magnetic resonance imaging (CMR) after excluding medical and metabolic comorbidity. Method In total, 80 participants underwent CMR to determine biventricular volumes and function and measures of blood pressure, physical activity and glycated haemoglobin levels. Individuals with schizophrenia (‘patients’) and controls were matched for age, gender, ethnicity and body surface area. Results Patients had significantly smaller indexed left ventricular (LV) end-diastolic volume (effect size d = −0.82, P = 0.001), LV end-systolic volume (d = −0.58, P = 0.02), LV stroke volume (d = −0.85, P = 0.001), right ventricular (RV) end-diastolic volume (d = −0.79, P = 0.002), RV end-systolic volume (d = −0.58, P = 0.02), and RV stroke volume (d = −0.87, P = 0.001) but unaltered ejection fractions relative to controls. LV concentricity (d = 0.73, P = 0.003) and septal thickness (d = 1.13, P < 0.001) were significantly larger in the patients. Mean concentricity in patients was above the reference range. The findings were largely unchanged after adjusting for smoking and/or exercise levels and were independent of medication dose and duration. Conclusions Individuals with schizophrenia show evidence of concentric cardiac remodelling compared with healthy controls of a similar age, gender, ethnicity, body surface area and blood pressure, and independent of smoking and activity levels. This could be contributing to the excess cardiovascular mortality observed in schizophrenia. Future studies should investigate the contribution of antipsychotic medication to these changes.

Adipose tissue dysfunction, inflammation, and insulin resistance: alternative pathways to cardiac remodelling in schizophrenia. A multimodal, case–control study

“…The patient sample in this study overlaps with our previously published MRI studies, including cardiac [ 9 , 10 ] and body fat [ 30 ] measures by MRI, while HCs show only partial overlap. Further details are in Supplementary Methods .…”

“…We have previously shown that patients with chronic schizophrenia show evidence of CCR [ 9 ] and increased myocardial T1 relaxation time, which is evidence of inflammation/fibrosis [ 10 ]. We have also shown that patients with chronic schizophrenia do not demonstrate differences in body fat content or distribution as compared to matched HCs [ 30 ].…”

“…We have recently shown that schizophrenia is characterised by CCR [ 9 ], which could explain part of the additional cardiovascular mortality in schizophrenia, as CCR has been shown to be associated with cardiovascular events in healthy adults [ 11 ].…”

“…Previous research has shown evidence for cardiac alterations in people with schizophrenia indicative of concentric cardiac remodelling (CCR) [ 9 ], myocardial tissue fibrosis, and/or inflammation [ 10 ]. CCR — the increase in the ratio of left ventricular (LV) mass over end-diastolic volume — is one of the strongest predictors of future CVD endpoints such as myocardial infarction, coronary insufficiency, heart failure, and stroke [ 11 ], while myocardial fibrosis independently predicts both cardiovascular and all-cause mortality [ 12 ].…”

Effectiveness of geropsychiatric home treatment concerning parameters of physical health: matched-pair study

“…Matched case-control study designs are commonly implemented in the field of public health and medical literature, 19,20 for example, in cancer research 21 and psychiatric research. 22,23 Data from the regional medical insurance company (RMIC) in Styria (a regional branch of the National Health Insurance in Austria) and data from the public hospitals in Styria were combined for both groups, and the patient pathways within 2016 were analysed for the statistical computing. The insurance data refer to the number of prescription drugs and the number of consultations with general practitioners (GPs) and extramural specialists in internal medicine and psychiatry, either panel doctors or private doctors of one's choice, whose bills are fully or partially paid by the health insurance in Austria.…”