The Role of Cardiac Biomarkers: Soluble Suppressor of Tumorigenicity 2 (sST2), B-type Natriuretic Peptide (BNP), and Cardiac Troponin I (cTnI) in Predicting Antidepressant and Antipsychotic-Induced Acute Cardiotoxicity.

Background: Poisoning from antidepressants and antipsychotics can lead to potentially life-threatening cardiotoxicity, which cardiac biomarkers can confirm. Aim of the work: This study aims to determine, for the first time, the value of sST2 in the early prediction of cardiotoxicity, alongside other cardiac injury biomarkers (BNP and cTnI), in cases of acute poisoning with antipsychotics and antidepressants. Patients and methods: This is a prospective cohort study involving selected cases of acute antidepressant and antipsychotic poisoning presented to Zagazig University Hospitals (ZUH) between June 2023 and December 2023. A detailed history was collected, and all cases underwent thorough clinical assessments, electrocardiography, routine investigations, and specific cardiac biomarkers, and received appropriate management tailored to each case. Results: Forty cases were enrolled, mostly aged between 18 and 40 years; the majority were females, suicidal, from urban areas, unmarried, students, with moderate poisoning severity, and primarily antipsychotic ingestion. Cardiotoxicity was diagnosed in about two-thirds of the cases, with one reported death. Dose, sinus tachycardia, poisoning severity score, extrapyramidal, and anticholinergic manifestations were significantly higher, while time since exposure and the Glasgow Coma scale were significantly lower, in the cardiotoxicity group. BNP level was the only cardiac biomarker significantly correlated with cardiotoxicity (p=0.03), with an AUC of 0.72 at 95% CI. Conclusion: BNP outperforms other cardiac biomarkers in the early prediction of cardiotoxicity during overdose of antidepressants and/or antipsychotics.