Skip to main content Accessibility help
×
Home

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

  • Emanuele F. Osimo (a1), Stefan P. Brugger (a2), Antonio de Marvao (a3), Toby Pillinger (a4), Thomas Whitehurst (a5), Ben Statton (a6), Marina Quinlan (a7), Alaine Berry (a7), Stuart A. Cook (a8), Declan P. O'Regan (a9) and Oliver D. Howes (a10)...

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.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

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

      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

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

      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

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

Copyright

This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.

References

Hide All
1Saha, S, Chant, D, Welham, J, McGrath, J.A systematic review of the prevalence of schizophrenia. PLoS Med 2005; 2(5): e141.
2Harris, C, Barraclough, B.Excess mortality of mental disorder. Br J Psychiatry 1998; 173: 1153.
3Laursen, TM, Munk-Olsen, T, Vestergaard, M.Life expectancy and cardiovascular mortality in persons with schizophrenia. Curr Opin Psychiatry 2012; 25: 83–8.
4Ösby, U, Westman, J, Hällgren, J, Gissler, M.Mortality trends in cardiovascular causes in schizophrenia, bipolar and unipolar mood disorder in Sweden 1987–2010. Eur J Public Health 2016; 26: 867–71.
5Olfson, M, Gerhard, T, Huang, C, Crystal, S, Stroup, TS.Premature mortality among adults with schizophrenia in the United States. JAMA Psychiatry 2015; 72: 1172–81.
6Correll, CU, Solmi, M, Veronese, N, Bortolato, B, Rosson, S, Santonastaso, P, et al. Prevalence, incidence and mortality from cardiovascular disease in patients with pooled and specific severe mental illness: a large-scale meta-analysis of 3,211,768 patients and 113,383,368 controls. World Psychiatry 2017; 16: 163–80.
7Laursen, TM.Life expectancy among persons with schizophrenia or bipolar affective disorder. Schizophr Res 2011; 131: 101–4.
8Parks, J, Svendsen, D, Singer, P, Foti, ME, Mauer, B.Morbidity and Mortality in People with Serious Mental Illness. National Association of State Mental Health Program Directors (NASMHPD) Medical Directors Council, 2006.
9Nasrallah, HA, Meyer, JM, Goff, DC, McEvoy, JP, Davis, SM, Stroup, TS, et al. Low rates of treatment for hypertension, dyslipidemia and diabetes in schizophrenia: data from the CATIE schizophrenia trial sample at baseline. Schizophr Res 2006; 86: 1522.
10Korkmaz, S, Korkmaz, H, Ozer, O, Atmaca, M.Assessment of left ventricle systolic and diastolic functions in schizophrenia patients. Psychiatry Res 2016; 240: 348–51.
11Chow, V, Yeoh, T, Ng, AC, Pasqualon, T, Scott, E, Plater, J, et al. Asymptomatic left ventricular dysfunction with long-term clozapine treatment for schizophrenia: a multicentre cross-sectional cohort study. Open Heart 2014; 1(1): e000030.
12Unsal, C, Oran, M, Tureli, HO, Alpsoy, S, Yesilyurt, S, Arslan, M, et al. Detection of subclinical atherosclerosis and diastolic dysfunction in patients with schizophrenia. Neuropsych Dis Treat 2013; 9: 1531–7.
13Bellenger, NG, Burgess, MI, Ray, SG, Lahiri, A, Coats, AJ, Cleland, JG, et al. Comparison of left ventricular ejection fraction and volumes in heart failure by echocardiography, radionuclide ventriculography and cardiovascular magnetic resonance. Are they interchangeable? Eur Heart J 2000; 21: 1387–96.
14Hundley, WG, Bluemke, DA, Finn, JP, Flamm, SD, Fogel, MA, Friedrich, MG, et al. ACCF/ACR/AHA/NASCI/SCMR 2010 expert consensus document on cardiovascular magnetic resonance: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents. J Am Coll Cardiol 2010; 55: 2614–62.
15de Marvao, A, Dawes, TJW, Shi, W, Durighel, G, Rueckert, D, Cook, SA, et al. Precursors of hypertensive heart phenotype develop in healthy adults: a high-resolution 3D MRI study. JACC: Cardiovasc Imaging 2015; 8: 1260–9.
16Kay, SR, Fiszbein, A, Opler, LA.The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophr Bull 1987; 13: 261–76.
17Dawes, TJ, Corden, B, Cotter, S, de Marvao, A, Walsh, R, Ware, JS, et al. Moderate physical activity in healthy adults is associated with cardiac remodeling. Circ Cardiovasc Imaging 2016; 9(8): e004712.
18Andreasen, NC, Pressler, M, Nopoulos, P, Miller, D, Ho, BC.Antipsychotic dose equivalents and dose-years: a standardized method for comparing exposure to different drugs. Biol Psychiatry 2010; 67: 255–62.
19Schulz-Menger, J, Bluemke, DA, Bremerich, J, Flamm, SD, Fogel, MA, Friedrich, MG, et al. Standardized image interpretation and post processing in cardiovascular magnetic resonance: Society for Cardiovascular Magnetic Resonance (SCMR) Board of Trustees Task Force on Standardized Post Processing. J Cardiovasc Magn Reson 2013; 15: 35.
20Woodbridge, M, Fagiolo, G, O'Regan, DP.MRIdb: medical image management for biobank research. J Digit Imaging 2013; 26: 886–90.
21Schiller, NB, Shah, PM, Crawford, M, DeMaria, A, Devereux, R, Feigenbaum, H, et al. Recommendations for quantitation of the left ventricle by two-dimensional echocardiography. J Am Soc Echocardiogr 1989; 2: 358–67.
22Corden, B, Keenan, NG, de Marvao, AS, Dawes, TJ, DeCesare, A, Diamond, T, et al. Body fat is associated with reduced aortic stiffness until middle age. Hypertension 2013; 61: 1322–7.
23Lubin, JH, Couper, D, Lutsey, PL, Woodward, M, Yatsuya, H, Huxley, RR.Risk of cardiovascular disease from cumulative cigarette use and the impact of smoking intensity. Epidemiology 2016; 27: 395404.
24Warburton, DE, Bredin, SS.Health benefits of physical activity: a systematic review of current systematic reviews. Curr Opin Cardiol 2017; 32: 541–56.
25Bennette, C, Vickers, A.Against quantiles: categorization of continuous variables in epidemiologic research, and its discontents. BMC Med Res Methodol 2012; 12: 21.
26Tsao, CW, Gona, PN, Salton, CJ, Chuang, ML, Levy, D, Manning, WJ, et al. Left ventricular structure and risk of cardiovascular events: a Framingham Heart Study Cardiac Magnetic Resonance Study. J Am Heart Assoc 2015; 4(9): e002188.
27Bluemke, DA, Kronmal, RA, Lima, JAC, Liu, K, Olson, J, Burke, GL, et al. The relationship of left ventricular mass and geometry to incident cardiovascular events: the MESA (Multi-Ethnic Study of Atherosclerosis) Study. J Am Coll Cardiol 2008; 52: 2148–55.
28Milani, RV, Lavie, CJ, Mehra, MR, Ventura, HO, Kurtz, JD, Messerli, FH.Left ventricular geometry and survival in patients with normal left ventricular ejection fraction. Am J Cardiol 2006; 97: 959–63.
29Gardin, JM, McClelland, R, Kitzman, D, Lima, JA, Bommer, W, Klopfenstein, HS, et al. M-mode echocardiographic predictors of six- to seven-year incidence of coronary heart disease, stroke, congestive heart failure, and mortality in an elderly cohort (the Cardiovascular Health Study). Am J Cardiol 2001; 87: 1051–7.
30Roman, MJ, Ganau, A, Saba, PS, Pini, R, Pickering, TG, Devereux, RB.Impact of arterial stiffening on left ventricular structure. Hypertension 2000; 36: 489–94.
31Bale, TL, Baram, TZ, Brown, AS, Goldstein, JM, Insel, TR, McCarthy, MM, et al. Early life programming and neurodevelopmental disorders. Biol Psychiatry 2010; 68: 314–9.
32Tintu, A, Rouwet, E, Ahmad, S, Ahmed, A, van Bilsen, M, Carmeliet, P, et al. Prenatal hypoxic stress causes cardiomyopathy involving cardiomyocyte specific vascular endothelial growth factor signaling. Circulation 2006; 114(suppl 18): II_4423.
33Slattery, M, Jacobs, DR Jr, Nichaman, M.Leisure time physical activity and coronary heart disease death. The US Railroad Study. Circulation 1989; 79(2): 304–11.
34Vancampfort, D, Firth, J, Schuch, FB, Rosenbaum, S, Mugisha, J, Hallgren, M, et al. Sedentary behavior and physical activity levels in people with schizophrenia, bipolar disorder and major depressive disorder: a global systematic review and meta-analysis. World Psychiatry 2017; 16: 308–15.
35McCreadie, RG.Diet, smoking and cardiovascular risk in people with schizophrenia: descriptive study. Br J Psychiatry 2003; 183: 534–9.
36Pillinger, T, McCutcheon, R, Vano, L, Mizuno, Y, Arumuhan, A, Hindley, G, et al. Comparative effects of 18 antipsychotics on metabolic function in schizophrenia, predictors of metabolic dysregulation, and association with psychopathology: a systematic review and network meta-analysis. Lancet Psychiatry 2019; https://doi.org/10.1016/S2215-0366(19)30416-X.
37Li, H, Wei, C, Gao, J, Bai, S, Li, H, Zhao, Y, et al. Mediation of dopamine D2 receptors activation in post-conditioning-attenuated cardiomyocyte apoptosis. Exp Cell Research 2014; 323: 118–30.
38Nikolić-Kokić, A, Tatalović, N, Nestorov, J, Mijović, M, Mijusković, A, Miler, M, et al. Clozapine, ziprasidone, and sertindole-induced morphological changes in the rat heart and their relationship to antioxidant enzymes function. J Toxicol Environ Health A 2018; 81: 844–53.
39Grimes, DA, Schulz, KF.Bias and causal associations in observational research. Lancet 2002; 359: 248–52.
40Kilian, JG, Kerr, K, Lawrence, C, Celermajer, DS.Myocarditis and cardiomyopathy associated with clozapine. Lancet 1999; 354: 1841–5.
41Bellissima, BL, Tingle, MD, Cicović, A, Alawami, M, Kenedi, C.A systematic review of clozapine-induced myocarditis. Int J Cardiol 2018; 259: 122–9.
42Cooper, LT Jr.Myocarditis. N Engl J Med 2009; 360: 1526–38.
43Pillinger, T, Osimo, EF, de Marvao, A, Berry, MA, Whitehurst, T, Statton, B, et al. Cardiac structure and function in patients with schizophrenia taking antipsychotic drugs: an MRI study. Transl Psychiatry 2019; 9: 163.
44Pillinger, T, Osimo, EF, Brugger, S, Mondelli, V, McCutcheon, RA, Howes, OD.A meta-analysis of immune parameters, variability, and assessment of modal distribution in psychosis and test of the immune subgroup hypothesis. Schizophr Bull 2019: 45: 1120–33.
45Khandaker, GM, Pearson, RM, Zammit, S, Lewis, G, Jones, PB.Association of serum interleukin 6 and C-reactive protein in childhood with depression and psychosis in young adult life: a population-based longitudinal study. JAMA Psychiatry 2014; 71: 1121–8.
46Seeland, U, Haeuseler, C, Hinrichs, R, Rosenkranz, S, Pfitzner, T, Scharffetter-Kochanek, K, et al. Myocardial fibrosis in transforming growth factor-β1 (TGF-β1) transgenic mice is associated with inhibition of interstitial collagenase. Eur J Clin Invest 2002; 32: 295303.
47Aijaz, B, Ammar, KA, Lopez-Jimenez, F, Red.f.ield, MM, Jacobsen, SJ, Rodeheffer, RJ.Abnormal cardiac structure and function in the metabolic syndrome: a population-based study. Mayo Clin Proc 2008; 83: 1350–7.
48Gandy, SJ, Lambert, M, Belch, J, Cavin, I, Crowe, E, Littleford, R, et al. 3T MRI investigation of cardiac left ventricular structure and function in a UK population: the Tayside Screening for the Prevention of Cardiac Events (TASCFORCE) study. J Magn Reson Imaging 2016; 44: 1186–96.

Keywords

Type Description Title
WORD
Supplementary materials

Osimo et al. supplementary material
Figure S1 and Tables S1-S5

 Word (253 KB)
253 KB

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

  • Emanuele F. Osimo (a1), Stefan P. Brugger (a2), Antonio de Marvao (a3), Toby Pillinger (a4), Thomas Whitehurst (a5), Ben Statton (a6), Marina Quinlan (a7), Alaine Berry (a7), Stuart A. Cook (a8), Declan P. O'Regan (a9) and Oliver D. Howes (a10)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

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

  • Emanuele F. Osimo (a1), Stefan P. Brugger (a2), Antonio de Marvao (a3), Toby Pillinger (a4), Thomas Whitehurst (a5), Ben Statton (a6), Marina Quinlan (a7), Alaine Berry (a7), Stuart A. Cook (a8), Declan P. O'Regan (a9) and Oliver D. Howes (a10)...
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *