Electrocardiogram Alterations Associated With Psychotropic Drug Use and CACNA1C Gene Variants in Three Independent Samples

Age and gender differences of basic electrocardiographic values and abnormalities in the general adult population; Tehran Cohort Study

BACKGROUND

Although several studies are available regarding baseline Electrocardiographic (ECG) parameters and major and minor ECG abnormalities, there is considerable controversy regarding their age and gender differences in the literature.

METHODS

Data from 7630 adults aged ≥ 35 from the Tehran Cohort Study registered between March 2016 and March 2019 were collected. Basic ECG parameters values and abnormalities related to arrhythmia, defined according to the American Heart Association definitions, were analyzed and compared between genders and four distinct age groups. The odds ratio of having any major ECG abnormality between men and women, stratified by age, was calculated.

RESULTS

The average age was 53.6 (± 12.66), and women made up 54.2% (n = 4132) of subjects. The average heart rate (HR) was higher among women(p < 0.0001), while the average values of QRS duration, P wave duration, and RR intervals were higher among men(p < 0.0001). Major ECG abnormalities were observed in 2.9% of the study population (right bundle branch block, left bundle branch block, and Atrial Fibrillation were the most common) and were more prevalent among men compared to women but without statistical significance (3.1% vs. 2.7% p = 0.188). Moreover, minor abnormalities were observed in 25.9% of the study population and again were more prevalent among men (36.4% vs. 17% p < 0.001). The prevalence of major ECG abnormalities was significantly higher in participants older than 65.

CONCLUSION

Major and minor ECG abnormalities were roughly more prevalent in male subjects. In both genders, the odds of having major ECG abnormalities surge with an increase in age.

The Effect of Antipsychotics and Their Combinations with Other Psychotropic Drugs on Electrocardiogram Intervals Other Than QTc among Jordanian Adult Outpatients

The ECG changes produced by antipsychotics and other psychotropic medications are studied mostly regarding QTc interval prolongation. This study aimed to investigate ECG changes beyond long QTc interval produced by psychotropic medications. A cross-sectional study was conducted to assess the effect of these agents on RR, PR, TpTe intervals and TpTe/QT ratio among Jordanian outpatients. The RR interval was significantly shorter among patients on TCAs versus those not receiving TCAs and among patients on polytherapy versus those on monotherapy (p < 0.05 for both comparisons), when adjusted for age, gender, BMI, caffeine intake, smoking, presence of diabetes mellitus, cardiovascular disease and medications known to produce heart rate changes. Positive correlations were found between the PR interval and age in patients treated with SGAs, SSRIs, citalopram, polytherapy and in the total sample (p < 0.01 for all). Inverse correlations were found between the RR interval and the number of psychotropic medications among patients treated with SSRIs and in the whole study sample (p < 0.01 for both). In conclusion, various ECG changes beyond QTc interval prolongation are observed in patients on antipsychotics and other psychotropic medications, in those on polytherapy. It is recommended to obtain an ECG before starting patients on psychotropic drugs known to produce electrocardiographic changes and their combinations.

Genetic factors contribute to medication-induced QT prolongation: A review

QT prolongation is a heart rhythm condition that impacts the lives of many people and when severe can be life-threatening. QT prolongation has been linked to variations in several genes, but it can also arise in the course of treatments with medications such as certain antipsychotics and antidepressants. However, it is unclear whether the risk of medication-induced QT prolongation (MIQTP) depends on specific genetic vulnerability. Here, we review the available literature on the interplay between genetic risk and medication exposure in the context of psychiatric treatment. A review was conducted on the genetic contribution to MIQTP in psychiatric patients. A literature search was conducted on the PubMed platform with 8 papers meeting criteria for review. A total of 3,838 patients from 8 studies meeting criteria for a psychotic or mood disorder were included in this review. All studies found evidence for the genetic contribution to MIQTP. The specific genes identified in these studies included the NOS1AP, ABCB1, KCNH2, SLC22A23, EPB41L4A, LEP, CACNA1C, CERKL, SLCO3A1, BRUNOL4, NRG3, NUBPL, PALLD, NDRG4 and PLN genes. The findings highlight both the importance of monitoring heart parameters in psychiatry and the possible role for genetic profiling to increase the treatment safety.

The Prevalence, Risk Factors and Clinical Correlates of QTc Prolongation in Chinese Hospitalized Patients With Chronic Schizophrenia

Background: The QTc interval may be significantly prolonged in schizophrenia patients taking antipsychotics. Few studies have addressed QTc prolongation (QTP) in Chinese patients. Objectives: This study was designed to evaluate the prevalence of QTP and its clinical correlates in Chinese hospitalized patients with chronic schizophrenia. Methods: A total of 436 inpatients and 291 normal controls matched with age and sex were included. QTc prolongation was defined as 2 standard deviations (SD) above the mean value of normal controls. Positive and Negative Syndrome Scale (PANSS) and its five-factor model were used to evaluate psychopathological symptoms. Results: QTc interval was significantly longer in patients than in normal controls. The prevalence of QTP is 8.26% in Chinese hospitalized patients with chronic schizophrenia. More women than men displayed QTP. Compared with patients without QTP, the patients with QTP had significantly higher concrete/disorganized subscore, lower low density lipoprotein (LDL) and lower total protein (TP). Furthermore, binary logistic regression analysis showed that higher number of hospitalizations, higher concrete/disorganized subscore and lower LDL were risk factors for QTP. Correlation analysis indicated significant association between QTc interval and the following variables: sex, age, duration of illness, the number of hospitalizations, PANSS total score, fasting blood glucose (FPG). Finally, a multiple regression analysis showed that older age, antipsychotic polypharmacy, higher PANSS total score, and lower LDL were risk factors for QTP. Among them, LDL seemed to be a protective factor for QTP. Conclusions: QTc interval was longer in schizophrenia patients than in normal controls. The prevalence of QTP is 8.26% in Chinese hospitalized patients with chronic schizophrenia. Some clinical characteristics were risk factors for QTP. And LDL seemed to be a protective factor for QTP.

EPB41L4A and LEP gene polymorphisms are associated with antipsychotic-induced QTc interval prolongation in Han Chinese

To identify the genetic factors related to antipsychotic-induced QTc interval prolongation (AIQTIP), we analyzed the associations between single nucleotide polymorphisms (SNPs) of candidate genes and quantitative traits of AIQTIP in a Han Chinese population. In total, we collected 112 hospitalized patients suffered from schizophrenia meeting the entry criteria, including 34 first-episode drug-naïve patients (FENP). All patients were treated with a single atypical antipsychotic drug (AAPD) for 4 weeks. We analyzed the quantitative genetic association between 10 SNPs in 8 candidate genes and AIQTIP using PLINK software. After 4 weeks of treatment, QTc interval of all patients was significantly prolonged and QTc interval of female patients was significantly longer compared with baseline. Antipsychotics have different effects on the prolongation of QTc. Quetiapine had the most distinct effect on AIQTIP. In all subjects, we found a significant association between the EPB41L4A gene SNP rs7732687 and AIQTIP. In male patients, we also found a significant association between the EPB41L4A gene SNP rs7732687 and AIQTIP. In female patients, we found the LEP gene SNP rs7799039 was significantly associated with AIQTIP. Our results provide preliminary evidence to support the genetic role of EPB41L4A and LEP in AIQTIP.

Corrected QT Interval Prolongation in Psychopharmacological Treatment and Its Modulation by Genetic Variation

Several antipsychotics and antidepressants have been associated with electrocardiogram alterations, the most clinically relevant of which is the heart rate-corrected QT interval (QTc) prolongation, a risk factor for sudden cardiac death. Genetic variants influence drug-induced QTc prolongation and can provide valuable information for precision medicine. The effect of genetic variants on QTc prolongation as well as the possible interaction between polymorphisms and risk medications in determining QTc prolongation were investigated. Medications were classified according to their known risk of inducing QTc prolongation (high-to-moderate, low, and no risk). QTc duration and risk of QTc > median value were investigated in a sample of 77 patients with mood or psychotic disorders being treated with antidepressants and antipsychotics, and who had at least 1 ECG recording. A secondary analysis considered QTc percentage change in patients (n = 25) with 2 ECG recordings. Single-nucleotide polymorphisms previously associated with QTc prolongation during treatment with psychotropic medications were investigated. No association survived after multiple-testing correction. The best results for modulation of QTc duration were identified for rs10808071 (the ABCB1 gene, nominal p = 0.007) when at least 1 medication with a moderate-to-high risk was prescribed, and for rs12029454 (the NOS1AP gene) in patients taking at least 1 medication with a cardiovascular risk (nominal p = 0.008). In the secondary analysis, rs2072413 (the KCNH2 gene) was the top finding for the modulation of QTc percentage change (nominal p = 0.001) when 1 drug with a moderate-to-high risk was added compared to baseline. Despite the limited power of this study, our results suggest that ABCB1, NOS1AP, and KCNH2 may play a role in QTc duration/prolongation during treatment with psychotropic drugs.

Design of FRET Probes for SNP RS1006737, Related to Mood Disorder

Background:

Several studies have shown that the Single Nucleotide Polymorphism (SNP) in the CACAN1C gene, rs1006737, is related to different mood disorder illnesses, such as bipolar disorder and schizophrenia. Current day molecular procedures for allele detection of this gene can be very expensive and time consuming. Hence, a sensitive and specific molecular procedure for detecting these mutations in a large number of subjects is desirable, especially for research groups who have no complex laboratory equipment.

Objective:

The possibility of using a Fluorescence Resonance Energy Transfer (FRET) probe was evaluated by means of bioinformatic tools, designed for forecasting the molecular behavior of DNA probes used in the research field or for laboratory analysis methods.

Method:

In this study we used the DINAMelt Web Server to predict the Tms of FRET oligo in the presence of the A and/or G allele in rs1006737. The PCR primers were designed by using oligo 4 and oligo 6 primer analysis software,

Results:

The molecular probe described in this study detected a Tm difference of 5-6°C between alleles A and G in rs1006737, which also showed good discrimination for a heterozygous profile for this genomic region.

Conclusion:

Although in silico studies represent a relatively new avenue of inquiry, they have now started to be used to predict how a molecular probe interacts with its biological target, reducing the time and costs of molecular test tuning. The results of this study seem promising for further laboratory tests on allele detection in rs1006737 region.

A molecular pathway analysis informs the genetic risk for arrhythmias during antipsychotic treatment

Arrhythmias are a frequent and potentially fatal side effect of antipsychotic treatment. Strict ECG monitoring and clinical interviews are the standards used to prevent arrhythmias. A biologic predictive tool is missing. The identification of a genetic makeup at risk of antipsychotic-induced arrhythmias is the aim of the present investigation. The aim of this study was to identify a molecular pathway enriched in single nucleotide polymorphisms associated with antipsychotic-induced QTc modifications. In total, 661 schizophrenic individuals from the CATIE study, M=486 (73.52%), mean age=40.92±11.02, were included. QTc variation was measured as a phase-specific change-created variable. A nested mixed regression for a repeated-measures model served in R for the analysis of the clinical and treatment-related covariates and molecular pathway analysis. Plink was used for the genetic genome-wide analysis. Quality checking was the standard (genotype call rate>0.95; minor allele frequency>0.01; Hardy-Weinberg equilibrium<0.0001) and the inflation factor was controlled by λ values. Quetiapine and perphenazine were associated with QTc variation during phase 1. No other significant association was detected. No significant inflation was detected. A number of molecular pathways were associated with QT variation at a conservative (adjusted) P value less than 0.05, including pathways related to neuronal wiring and collagen biosynthesis, along with pathways related to K+ currents and cardiac contraction. Pathways related to neuronal wiring, collagen biosynthesis, and ion currents were identified as possibly involved in QTc modifications during antispsychotic treatment in SKZ patients.