Electrocardiographic Findings in First-Episode Schizophrenia Patients: QT, QTc, P-Wave Dispersion, and Tp-e/QTc Ratio

Abstract

To investigate the electrocardiographic results of newly diagnosed first-episode schizophrenia patients compared with healthy controls. This study included 70 individuals (35 diagnosed with schizophrenia according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, criteria and 35 healthy controls). Resting supine electrocardiography (ECG) recordings were obtained for all of the participants and evaluated by the same cardiologist. The heart rate, P wave durations, QT interval, Tpeak-to-Tend (Tp-e) value, P wave dispersion (PWD), QT dispersion, and Tp-e dispersion were calculated. There were no statistically significant differences in the demographic data among the participants. The mean age of the patient group was 27.06 ± 7.53 years, while that of the control group was 26.77 ± 4.33 years (p > 0.05). The QT interval dispersion, PWD, Tp-e dispersion, and corrected QT (QTc) dispersion durations were higher in the patient group compared to the control group (p < 0.05). The minimum Tp-e value and Tp-e/QTc ratio were lower in the patient group. Considering the obtained data, it can be suggested that even at the time of initial diagnosis without prior treatment, patients with schizophrenia are at risk for cardiac arrhythmias and rhythm disorders. Therefore, it is recommended that physicians take potential cardiac conduction issues into account when evaluating these patients and initiating medical treatment.

Keywords

• Schizophrenia
• first-episode
• electrocardiography
• heart rate
• QTc dispersion
• P wave dispersion
• Tp-e dispersion

References

1. 1. McCutcheon RA, Reis Marques T, Howes OD. Schizophrenia-An Overview. JAMA Psychiatry. 2020; 77: 201-210.
2. 2. Marder SR, Cannon TD. Schizophrenia. N. Engl. J. Med. 2019; 381: 1753–1761.
3. 3. Singh S, Roy D, Marzouk T, Zhang JP. Peripheral Blood Levels of Brain-Derived Neurotrophic Factor in Patients with First Episode Psychosis: A Systematic Review and Meta-Analysis. Brain Sciences. 2022; 12(4): 414.
4. 4. Lesh TA, Careaga M, Rose DR, McAllister AK, Van de Water J, Carter CS, et al. Cytokine alterations in first-episode schizophrenia and bipolar disorder: relationships to brain structure and symptoms. J Neuroinflam. 2028; 15(1):1-11.
5. 5. Chesney E, Goodwin GM, Fazel S. Risks of all-cause and suicide mortality in mental disorders: a meta-review. World Psychiatry. 2014; 13(2):153–160.
6. 6. Olfson 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
7. 7. Šimunović IF, Filipčić I. Schizophrenia and Physical Comorbidity. Psychiatria Danubina. 2028; 30(4): 152-157.
8. 8. Hennekens CH, Hennekens AR, Hollar D, Casey DE. Schizophrenia and increased risks of cardiovascular disease. Am Heart J. 2005;150(6):1115–1121.

9. 9. Riordan HJ, Antonini P, Murphy MF. Atypical antipsychotics and metabolic syndrome in patients with schizophrenia: risk factors, monitoring, and healthcare implications. Am Health Drug benefits. 2011; 4(5): 292.
10. 10. Baskovski, E, Altin AT, Candemir B, Akyurek O, Esenboga K, Tutar E. Relationship between left atrial scar and P wave dispersion in patients undergoing atrial fibrillation catheter ablation. Acta Cardiologica. 2022; 77(7): 586-592.
11. 11. Castro-Torres Y, Carmona-Puerta R, Katholi RE. Ventricular repolarization markers for predicting malignant arrhythmias in clinical practice. World J Clin Cases. 2015;3(8):705-20.
12. 12. Lang CN, Menza M, Jochem S, Franke G, Feliz SP, Brunner M, et al. Electro-mechanical dysfunction in long QT syndrome: role for arrhythmogenic risk prediction and modulation by sex and sex hormones. Progress in Biophysics and Molecular Biology. 2016; 120(1-3): 255-269
13. 13. Özsoy F, Zorlu Ç, Kaya Ş. Electrocardiographic evaluation of the ventricular arrhythmia risk in patients with schizophrenia. Anatolian J Psychiatr. 2021; 22, 85.
14. 14. Demir B, Özsoy F, Büyük A, Altindag A. The effects of methamphetamine on electrocardiographic parameters in male patients. Int J Psychiatr Clin Practice. 2022; 1-6.
15. 15. Demir B, Özsoy F, Büyük A, Altindag A. ECG changes in patients with opioid use disorder; P-QT wave dispersion: a retrospective study. J Addictive Diseases. 2020; 39(2): 234-240.
16. 16. Yavuzkir MF, Atmaca M, Gurok MG, Adıyaman Ş. P wave dispersion in obsessive-compulsive disorder. Indian J Psychiatry. 2015;57(2):196–199.
17. 17. Atmaca M, Yavuzkir M, Izci F, Gurok MG, Adıyaman Ş. QT wave dispersion in patients with panic disorder. Neurosci Bull. 2012;28(3):247–252.
18. 18. Gurok MG, Korkmaz H, Yıldız S, Bakış D, Atmaca M. QT and P-wave dispersion during the manic phase of bipolar disorder. Neuropsychiatr Disease Treat. 2019; 15: 1805.
19. 19. Montaquila JM, Trachik BJ, Bedwell JS. Heart rate variability and vagal tone in schizophrenia: a review. J Psychiatr Res. 2015; 69: 57-66.
20. 20. Beauchaine TP, Thayer JF. Heart rate variability as a transdiagnostic biomarker of psychopathology. Int J Pychophysiol. 2015; 98(2): 338-350.
21. 21. Clamor A, Lincoln TM, Thayer JF, Koenig J. Resting vagal activity in schizophrenia: meta-analysis of heart rate variability as a potential endophenotype. British J Psychiatr. 2016; 208(1): 9-16.
22. 22. Berger S, Boettger MK, Tancer M, Guinjoan SM, Yeragani VK, Bär KJ. Reduced cardio-respiratory coupling indicates suppression of vagal activity in healthy relatives of patients with schizophrenia. Prog Neuro- Psychopharmacol Biological Psychiatr. 2010; 34(2): 406-411.
23. 23. Baykara S, Yılmaz M, Baykara M. QT dispersion and P wave dispersion in schizophrenia. Psychiatr Clinic Psychopharmacol. 2019; 29(4): 538-543.
24. 24. Benjamin EJ, Virani SS, Callaway CW, Chamberlain AM, Chang AR, Cheng S, et al; American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. heart disease and stroke statistics—2018 update: a report from the American Heart Association. Circulation. 2018;137(12):e67- e492.
25. 25. Staerk L, Wang B, Preis SR, Larson MG, Lubitz SA, Ellinor PT, et al. Lifetime risk of atrial fibrillation according to optimal, borderline, or elevated levels of risk factors: cohort study based on longitudinal data from the Framingham Heart Study. BMJ. 2018; 361:1453.
26. 26. January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS Guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/ American Heart Association task force on clinical practice guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2019;74(1):104-132.
27. 27. Fenger-Grøn M, Vestergaard CH, Ribe AR, Johnsen SP, Frost L, Sandbæk A, Det al. Association between bipolar disorder or schizophrenia and oral anticoagulation use in Danish adults with incident or prevalent atrial fibrillation. JAMA network open. 2021; 4(5): 2110096-2110096.
28. 28. Jones C, Pollit V, Fitzmaurice D, Cowan C. The management of atrial fibrillation: summary of updated NICE guidance. Br. Med. J. 2014; 348: 3655.
29. 29. Farran D, Feely O, Ashworth M, Gaughran F. Anticoagulation therapy and outcomes in patients with atrial fibrillation and serious mental illness: A systematic review and meta-analysis. J Psychiatr Res. 2022; 156:733-753.
30. 30. Jindal RD, Keshavan MS, Eklund K, Stevens A, Montrose DM, Yeragani VK. Beat-to-beat heart rate and QT interval variability in first episode neuroleptic-naive psychosis. Schizophrenia Res. 2009; 113(2-3):176-180.
31. 31. Erikssen G, Liestøl K, Gullestad L, Haugaa KH, Bendz B, Amlie JP. The terminal part of the QT interval (T peak to T end): a predictor of mortality after acute myocardial infarction. Ann Noninvasive Electrocardiol. 2012;17:85- 94.