Joy George, Whiskey Eromona, Bolstridge Mark, Porras-Segovia Alejandro, McDonagh Theresa A, Plymen Carla M, Shergill Sukhi S
From the *Department of Cardiology, King's College Hospital, NHS Foundation Trust; †Pharmacy Department, South London & Maudsley Hospital, Denmark Hill, United Kingdom; ‡Mental Health Service, Granada University Hospital, Granada, Spain; §Cardiology Department, King's College Healthcare NHS Foundation Trust, Denmark Hill; ∥Cardiology Department, Imperial College Healthcare NHS Trust, Hammersmith Hospital, Du Cane Road, London; ¶Institute of Psychiatry, Psychology and Neuroscience, King's College London and Maudsley Hospital London, Denmark Hill, United Kingdom.
J Clin Psychopharmacol. 2017 Dec;37(6):708-712. doi: 10.1097/JCP.0000000000000792.
Schizophrenia has a 1% prevalence in the population; 30% of these patients are treatment refractory. Clozapine is the only drug licensed to treat treatment refractory psychosis, but concerns about potential adverse effects result in only a proportion of eligible patients being treated. Although a well-documented neutropenia risk is mitigated by routine blood testing, cardiac toxicity is a commonly cited reason to discontinue clozapine treatment. However, there is little data on the real-life cardiac outcomes in those receiving clozapine treatment.
Retrospective review of electrocardiogram, echocardiogram, and clinical outcomes in 39 inpatients with treatment-refractory schizophrenia, treated with clozapine and other antipsychotic medication, referred for cardiology opinion.
Commonest reasons for referral were development of left ventricular (LV) impairment or sinus tachycardia with normal LV function. Patients were reviewed by a range of cardiologists, receiving varied interventions.Median LV ejection fraction in the clozapine group was normal (52%). Serial echocardiograms demonstrated that clozapine-treated patients with LV impairment had no change in LV ejection fraction over a 4-month follow-up. Left ventricular ejection fraction did not differ between patients treated with clozapine and other antipsychotics. However, over an 11-year follow-up period, 48% of patients had discontinued clozapine treatment.
This naturalistic study demonstrates that clozapine is not associated with significant cardiac mortality or morbidity. There is a real need for multidisciplinary working between specialist cardiologists and psychiatrists caring for these complex patients to facilitate optimal long-term physical and mental health outcomes.
精神分裂症在人群中的患病率为1%；其中30%的患者对治疗无效。氯氮平是唯一被许可用于治疗难治性精神病的药物，但由于对潜在不良反应的担忧，只有一部分符合条件的患者接受治疗。尽管常规血液检测可减轻已被充分记录的中性粒细胞减少风险，但心脏毒性是停用氯氮平治疗的常见原因。然而，关于接受氯氮平治疗患者的实际心脏结局的数据很少。
回顾性分析39例难治性精神分裂症住院患者的心电图、超声心动图及临床结局，这些患者接受氯氮平及其他抗精神病药物治疗，并被转诊至心脏病科寻求意见。
转诊的最常见原因是左心室（LV）功能损害或左心室功能正常的窦性心动过速。由多位心脏病专家对患者进行了评估，并采取了不同的干预措施。氯氮平组的左心室射血分数中位数正常（52%）。系列超声心动图显示，在4个月的随访中，氯氮平治疗的左心室功能损害患者的左心室射血分数没有变化。氯氮平治疗患者与其他抗精神病药物治疗患者的左心室射血分数没有差异。然而，在11年的随访期内，48%的患者停用了氯氮平治疗。
这项观察性研究表明，氯氮平与显著的心脏死亡率或发病率无关。对于照顾这些复杂患者的专科心脏病专家和精神科医生而言，确实需要开展多学科合作，以促进实现最佳的长期身心健康结局。
