Chen Pao-Huan, Hsiao Cheng-Yi, Wang Jiunn-Kae, Ku Hsiao-Lun, Chung Kuo-Hsuan, Tsai Shang-Ying
Department of Psychiatry, Taipei Medical University Hospital, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan; Cardiovascular Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan; Division of Cardiology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Gen Hosp Psychiatry. 2025 Jan-Feb;92:40-45. doi: 10.1016/j.genhosppsych.2024.12.011. Epub 2024 Dec 17.
Allostatic load refers to the pathophysiological consequences of uncompensated adaptation to chronic stress. Few studies have investigated the effect of allostatic load on cardiac health in patients with serious mental disorders (SMDs), a population at high risk of cardiac mortality. Herein we evaluated associations between allostatic load and cardiac structure and function in young adults with SMDs.
A total of 106 participants aged younger than 45 years underwent echocardiographic study, blood biochemistry examination, and blood cell count analysis. Echocardiographic imaging was conducted in accordance with recommendations of the American Society of Echocardiography and European Association of Cardiovascular Imaging. Allostatic load index was calculated using 15 measures representing cardiovascular, metabolic, and inflammatory or oxidative stress markers.
The SMD group exhibited a significantly higher allostatic load index than did control (Cohen's d = 0.59). Additionally, they exhibited a greater left ventricular relative wall thickness (LVRWT, Cohen's d = 0.39) and a less favorable mitral valve E/A ratio (Cohen's d = 0.31), left ventricular ejection fraction (Cohen's d = 0.51), and global longitudinal strain (Cohen's d = 0.71). After demographic and clinical characteristics were adjusted for, multiple linear regression revealed that allostatic load index was positively associated with LVRWT (β = 0.255) and negatively associated with mitral valve E/A ratio (β = -0.247) in the SMD group.
This is the first study to suggest that allostatic load may play a critical role in accelerated adverse cardiac remodeling among young patients with SMDs. Future studies should elucidate the underlying mechanisms.
应激负荷指的是对慢性应激进行未补偿适应所产生的病理生理后果。很少有研究调查应激负荷对严重精神障碍（SMD）患者心脏健康的影响，这是一个心脏死亡率很高的人群。在此，我们评估了应激负荷与患有SMD的年轻成年人心脏结构和功能之间的关联。
共有106名年龄小于45岁的参与者接受了超声心动图研究、血液生化检查和血细胞计数分析。超声心动图成像按照美国超声心动图学会和欧洲心血管影像协会的建议进行。使用代表心血管、代谢以及炎症或氧化应激标志物的15项指标计算应激负荷指数。
SMD组的应激负荷指数显著高于对照组（科恩d值 = 0.59）。此外，他们的左心室相对壁厚度更大（科恩d值 = 0.39），二尖瓣E/A比值、左心室射血分数和整体纵向应变更不理想（科恩d值分别为0.31、0.51和0.71）。在对人口统计学和临床特征进行调整后，多元线性回归显示，在SMD组中，应激负荷指数与左心室相对壁厚度呈正相关（β = 0.255），与二尖瓣E/A比值呈负相关（β = -0.247）。
这是第一项表明应激负荷可能在患有SMD的年轻患者加速不良心脏重塑中起关键作用的研究。未来的研究应阐明其潜在机制。
