Dipartimento Area Critica, Università di Firenze, Firenze, Italy.
J Clin Psychopharmacol. 2011 Dec;31(6):712-6. doi: 10.1097/JCP.0b013e318234ee66.
Available information regarding clozapine-related cardiomyopathy is limited to reports of severe left ventricular dysfunction not rarely with fatal clinical evolution. A subclinical cardiotoxic effect might be diagnosed using echocardiography and N-terminal pro-B-type natriuretic peptide assay.
Thirty-eight patients with psychotic disorder in chronic therapy with clozapine (24 male and 14 female subjects; mean age, 38.4 years) were enrolled. Left ventricular ejection fraction (LVEF) was measured by area-length method (average of 5 measurements).
Twelve patients showed a mild depression of left ventricular function (LVEF between 50% and 55%), 2 LVEF less than 50% and 1 less than 30%. The area under the receiver operating characteristic curve for N-terminal pro-B-type natriuretic peptide as a predictor of left ventricular dysfunction was 0.87.
A subclinical left ventricular dysfunction was found in 3 of 38 patients, whereas a mild impairment of the left ventricular systolic function occurred in 1 of 3 of young, previously healthy, clozapine-treated patients A prospective study in clozapine-naive patients may be useful to better understand cardiotoxic effects of clozapine.
有关氯氮平相关性心肌病的可用信息仅限于严重左心室功能障碍的报告，且常伴有致命的临床进展。超声心动图和 N 端脑利钠肽前体检测可用于诊断亚临床心脏毒性。
共纳入 38 例接受慢性氯氮平治疗的精神障碍患者（24 名男性，14 名女性；平均年龄 38.4 岁）。通过面积长度法（平均 5 次测量）测量左心室射血分数（LVEF）。
12 例患者出现轻度左心室功能障碍（LVEF 在 50%~55%之间），2 例 LVEF 小于 50%，1 例小于 30%。N 端脑利钠肽前体预测左心室功能障碍的受试者工作特征曲线下面积为 0.87。
38 例患者中有 3 例存在亚临床左心室功能障碍，3 例年轻、既往健康、接受氯氮平治疗的患者中有 1 例出现轻度左心室收缩功能障碍。在氯氮平初治患者中开展前瞻性研究可能有助于更好地了解氯氮平的心脏毒性作用。
