Association between the number of acute episodes and increased cardiac left ventricular mass index in patients diagnosed with schizophrenia

Patients with schizophrenia have a high risk of cardiovascular death. Increased cardiac left ventricular (LV) mass has been reported to be associated with heart failure and cardiac mortality. However, few studies have used echocardiographic imaging to evaluate the associations between cardiac LV mass and the clinical characteristics of schizophrenia. We recruited 121 adults to undergo standard and two-dimensional speckle-tracking echocardiography. Cardiac LV mass was determined using the Devereux formula and indexed with reference to the body surface area to obtain the cardiac LV mass index (LVMI). Clinical and demographic data were obtained through interviews and chart review. The results showed that relative to the mentally healthy controls (n = 55), individuals with schizophrenia (n = 66) had significantly higher mean values of cardiac LVMI as well as lower mitral valve E/A ratio, LV ejection fraction, and LV global longitudinal strain. Among the individuals with schizophrenia, cardiac LVMI was positively correlated with the number of acute episodes, and this association remained significant after adjustment for age, age at onset, and body mass index. On the contrary, there were no significant associations between cardiac LVMI and traditional cardiovascular risk factors. Taken together, this study suggests that the burden of psychotic symptoms may contribute to the increased risk of cardiac hypertrophy in individuals with schizophrenia independent of traditional cardiovascular risk factors. Because cardiac hypertrophy is among the major risk factors of heart failure and cardiac mortality, future research must investigate the mechanisms underlying the association between psychosis and increased cardiac LV mass.