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Published on: July 20, 2022
Volumetric and Functional Features of Left Atrium in Chronic Schizophrenia-Detailed Analysis from Three-Dimensional
Attila Nemes1, Renáta Halcsik1, Árpád Kormányos1
1Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis Street 8, P.O. Box 427, H-6725 Szeged, Hungary.
Insights
Patients with schizophrenia exhibit significant left atrial abnormalities, including reduced volumes and altered function. These findings underscore the need for comprehensive cardiac assessments in this population.
Area of Science:
- Cardiology
- Psychiatry
- Medical Imaging
Background:
- Cardiovascular disease is prevalent in schizophrenia patients, with underdiagnosis and undertreatment.
- Limited data exists on cardiac structural and functional abnormalities, especially concerning the left atrium (LA).
Purpose of the Study:
- To investigate left atrial (LA) volumetric and functional properties in chronic schizophrenia (SCH) patients using 3D speckle-tracking echocardiography (3DSTE).
- To compare LA function in SCH patients with age-, gender-, and BMI-matched healthy controls (HCs).
Main Methods:
- Utilized 3DSTE to assess LA volumes and function in 17 SCH patients and 40 HCs.
- Comprehensive two-dimensional Doppler echocardiography was also performed.
Main Results:
- SCH patients showed reduced LA volumes across all cardiac cycle phases.
- Significant alterations in LA function were observed, including reduced stroke volumes and increased passive emptying fraction.
- Increased global and regional LA strain parameters (area strain, radial strain, circumferential strain, longitudinal strain) were noted in SCH patients, indicating overcompensating functional changes.
Conclusions:
- Chronic schizophrenia is linked to significant left atrial volumetric and functional abnormalities.
- These findings emphasize the necessity of comprehensive cardiac evaluations in schizophrenia patients, extending beyond left ventricular analysis.
Abstract:
Introduction: Health problems related to cardiovascular morbidity and mortality are overrepresented in patients with schizophrenia (SCH) and their rates have not declined in parallel with those of the general population. Cardiovascular diseases in patients with SCH are less likely to be diagnosed and treated, and data regarding structural and functional cardiac abnormalities-particularly those involving the left atrium (LA)-remain limited in this population. The present study is the first to provide a detailed three-dimensional speckle-tracking echocardiography (3DSTE)-derived volumetric and functional evaluation of LA properties in patients with chronic SCH compared with age-, gender- and body mass index (BMI)-matched healthy controls (HCs). Methods: A total of 36 patients with SCH were initially enrolled, from which 19 subjects (53%) were excluded due to inferior image quality. Ultimately, 17 SCH patients (mean age: 45.2 ± 7.7 years; 9 males, 53%) were compared with 40 age- and gender-matched HCs (mean age: 42.5 ± 5.7 years; 23 males, 58%). All participants underwent comprehensive two-dimensional Doppler echocardiography and 3DSTE. Results: LA volumes respecting the cardiac cycle were lower in SCH patients compared with controls. Among LA volume-derived functional properties, total and active LA stroke volumes were reduced in patients with chronic SCH, whereas passive LA emptying fraction was increased. All global and mean segmental peak LA strain parameters tended to be increased in SCH patients, with global and mean segmental LA area strain (AS) and mean segmental LA radial strain (RS) reaching statistical significance. Regarding regional peak LA strains, basal LA circumferential strain (CS) and LA-AS, as well as superior LA longitudinal strain (LS), LA-CS, and LA-AS, differed significantly between the groups. All global and mean segmental LA strain parameters measured at atrial contraction tended to be increased in chronic SCH patients, with global and mean segmental LA-AS and mean segmental LA-RS and LA-LS reaching statistical significance. Regional LA strains during atrial contraction demonstrated increased superior LA-RS, LA-CS, LA-LS and LA-AS, along with elevated mid-atrial LA-RS, LA-AS and LA-3D strain. All these abnormalities suggest reduced LA volumes in all phases of LA function, accompanied by overcompensating functional alterations. Conclusions: Chronic schizophrenia is associated with marked volumetric and functional abnormalities of the left atrium. These findings highlight the need for comprehensive cardiac functional evaluation extending beyond left ventricular-centered analysis in patients with this severe mental illness.
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