Selective Serotonin Reuptake Inhibitor Use Is Associated with Right Ventricular Structure and Function: The MESA-Right Ventricle Study

Abstract

PurposeSerotonin and the serotonin transporter have been implicated in the development of pulmonary hypertension (PH). Selective serotonin reuptake inhibitors (SSRIs) may have a role in PH treatment, but the effects of SSRI use on right ventricular (RV) structure and function are unknown. We hypothesized that SSRI use would be associated with RV morphology in a large cohort without cardiovascular disease (N = 4114).MethodsSSRI use was determined by medication inventory during the Multi-Ethnic Study of Atherosclerosis baseline examination. RV measures were assessed via cardiac magnetic resonance imaging. The cross-sectional relationship between SSRI use and each RV measure was assessed using multivariable linear regression; analyses for RV mass and end-diastolic volume (RVEDV) were stratified by sex.ResultsAfter adjustment for multiple covariates including depression and left ventricular measures, SSRI use was associated with larger RV stroke volume (RVSV) (2.75 mL, 95% confidence interval [CI] 0.48–5.02 mL, p = 0.02). Among men only, SSRI use was associated with greater RV mass (1.08 g, 95% CI 0.19–1.97 g, p = 0.02) and larger RVEDV (7.71 mL, 95% 3.02–12.40 mL, p = 0.001). SSRI use may have been associated with larger RVEDV among women and larger RV end-systolic volume in both sexes.ConclusionsSSRI use was associated with higher RVSV in cardiovascular disease-free individuals and, among men, greater RV mass and larger RVEDV. The effects of SSRI use in patients with (or at risk for) RV dysfunction and the role of sex in modifying this relationship warrant further study.

Sex and haemodynamics in pulmonary arterial hypertension

“…Haemodynamic and morphological parameters of RV function are important predictors of survival in PAH, and females tend to have more favourable RV indices than males [3, 8–10]. In health, males have accelerated cardiomyocyte loss with ageing, lower RV ejection fraction and larger age-related decrements in RV mass as compared with females, although age-related changes in RV function have not been studied in a large-scale manner in PAH [22, 48–50]. …”

Poststroke Depression and Risk of Recurrent Stroke at 1 Year in a Chinese Cohort Study

“…Studies show that excessive reduction of blood pressures during acute stroke stage might exacerbate neurological deterioration [19] . Lastly, anti-depressant drugs have potential side effects that might influence the results [22] – [23] . The correlation between anti-depressant drugs and recurrent stroke requires further clarification by high quality randomized controlled triasl.…”

Assessment of Right Ventricular Function in the Research Setting: Knowledge Gaps and Pathways Forward. An Official American Thoracic Society Research Statement

“…Study, the Framingham Heart Study, and other cohorts (28)(29)(30)(31)(32)(33)(34)(35). However, these observations need to be validated 1) in health and disease, 2) longitudinally, and 3) in other populations.…”