Myocardial deformation and pro-arrhytmic indices in a group of first-episode patients with psychosis after one year of antipsychotic treatment

Introduction Heart Rate Variability assesses the autonomic system function. We have previously reported increased sympathetic activation (i.e. increased proarrhythmic risk) and asymptomatic left ventricular myocardial dysfunction in a group of drug-naïve, First Episode Patients with psychosis. We performed the same cardiological evaluation in a subgroup of these patients one year after the initiation of antipsychotic treatment. Objectives To find out the impact of antipsychotic medications in cardiac function. Methods Thirty three consecutive patients diagnosed with first psychotic episode were included in the current analysis. None of the patients had a previous history of cardiovascular diseases. All patients were assessed by 24-hour Holter ECG monitoring (including QT analysis and heart rate variability indices) and a thorough echocardiographic study (including myocardial strain analysis – global longitudinal strain GLS) at baseline (shortly after stabilization) and 1 year after treatment. Results The mean age of our population was 29±7 years, 75% were males and their body surface area was 1.87±0.21 m 2 . At baseline 1) the mean value of QTc was normal in all subjects although the greatest QTc value measured was above 500msec in 35% of patients, 2) SDNNI<50 msec was observed in 50% of the patients, all patients had an abnormal HRV index, low RMSSD <20 msec was observed in 35% of patients, no patient had abnormally low PNN50 values. No patient had evidence of overt structural heart disease and the value of left ventricular ejection fraction was within normal range (57.5±5.1 %). GLS was decreased (i.e. < -16%) in 25% of patients. At follow-up maximum QTc value (517±52 vs 485±69, p=0.014) and PNN50 (14.1±12.1 vs 9.8±10.5, p=0.05) were increased while left atrial volume index (20.1±6.3 vs 23.3±6.4, p=0.031) and GLS (-18.6±2.5 vs -17.5±2.5, p=0.007) were decreased compared to baseline. No other significant changes were observed at follow-up. At follow-up, abnormal GLS, QTc max, SDNNI, HRV index, RMSSD and PNN50 values were observed in 16%, 60%, 38%, 96%, 15% and 0% respectively of included patients. Normal values SDNNI >100 (especially <50) HRV INDEX >60 RMSSD 13-48 MS Pnn50 -3 – 43% Conclusions In patients with a first psychotic episode without a previous history of cardiovascular disease or risk factors, a significant proportion showed abnormal autonomous system function and subclinical myocardial dysfunction of the left ventricle. After 1 year of treatment, improvement was observed in left ventricular function and parasympathetic system activity with a concomitant increase QTc interval. Optimal management of psychotic episodes may lead to an amelioration of the risk of future myocardial impairment without affecting the risk for arrhythmias and sudden death. Disclosure of Interest None Declared