Is methylphenidate truly cardiac-safe? Insight from biventricular speckle tracking echocardiography in pediatric patients with attention deficit hyperactivity disorder

Abstract Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental condition identified by inattention, hyperactivity, and impulsivity. ADHD pharmacotherapy, particularly methylphenidate (MPH), has raised concerns about its cardiovascular safety. We aimed to assess the impact of methylphenidate on cardiac function in pediatric patients with ADHD using two-dimensional speckle tracking echocardiography (2D-STE). This study was performed on 40 children with newly diagnosed ADHD as the patient group and 40 age- and sex-matched healthy controls. Electrocardiographic screening and echocardiographic evaluations were conducted at baseline and after 6 months of MPH treatment. Heart rate (HR) and systolic and diastolic blood pressure (SBP, DBP) were also recorded. HR, SBP and DBP, were significantly elevated after treatment compared with their pre-treatment values. Diastolic functions of the left and right ventricles measured by tissue Doppler echocardiography (TDE) decreased significantly after treatment compared to their pretreatment values. Moreover, right and left ventricular systolic function measured by 2D-STE was significantly reduced after treatment compared to their pretreatment values. However, conventional echocardiography failed to detect any changes. None of our patients experienced any arrhythmias throughout the study duration. Conclusion : Subclinical cardiac systolic and diastolic alterations were detected in pediatric ADHD patients treated with methylphenidate. The safety of the drug for the heart is warranted; therefore, careful patient selection, baseline cardiovascular assessment, and follow-up of these patients are strongly recommended. What is Known: • Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental condition characterized by inattention, hyperactivity, and impulsivity. • ADHD pharmacotherapy, particularly methylphenidate (MPH), has raised concerns about its cardiovascular safety. No sufficient data about its cardiac safety in pediatrics. What is New: • We investigated, for the first time, the effect of methylphenidate on cardiac function in pediatric patients with ADHD using two-dimensional speckle tracking echocardiography. • We found subclinical cardiac systolic and diastolic alterations in pediatric ADHD patients treated with methylphenidate. The safety of the drug on the heart is warranted; therefore, careful patient selection, baseline cardiovascular assessment, and follow-up of these patients are strongly recommended.