Effects Of Atypical Antipsychotic Drugs On Electrocardiogram And Myocardial Enzymes

Objective:To compare the effects of 7 atypical antipsychotics on ECG and myocardial enzymes of patients,and to provide some guidance for clinical practice.Methods:A self-made general situation questionnaire was used to collect demographic data,course of disease,medication during hospitalization,ECG and myocardial enzyme data at admission,weekend2,weekend 4,weekend 6 and weekend 8 of 500 schizophrenic inpatients.Chi-square test,variance analysis and other statistical methods were used to analyze the data.Results:Electrocardiogram abnormalities were found in 7groups(clozapine,olanzapine,risperidone,quetiapine,aripiprazole,amisulpri de and ziprasidone groups),of which ischemic changes(ST-T changes,T wave changes,ST segment changes)were the most common,followed by sinus tachycardia,QTc interval extension,sinus bradycardia arrhythmia.The heart rate of clozapine group increased at the end of 2 weeks,while that of olanzapine group and aripiprazole group began to increase at the end of 4 weeks and lasted until 8 weeks(F=5.841,P=0.003;F=4.195,P=0.009;F=3.108,P=0.017);The heart rate of patients in risperidone group and amisulpride group began to increase at the end of 2 weeks and lasted until the end of 8 weeks(F=7.256,p=0.001;F=8.293,P=0.000);There was no significant change in heart rate in olanzapine group,quetiapine group,ziprasidone group and aripiprazole group.In clozapine group,amisulpride group,quetiapine group and ziprasidone group,QTc interval was significantly prolonged from weekend 2 to weekend 8(F=3.582,P=0.014;F=6.115,P=0.000;F=5.865,P=0.001;F=9.043,P=0.000).The incidence of ischemia is highest in clozapine group and lowest in aripiprazole group,followed by olanzapine group>risperidone group>ziprasidone group>quetiapine group>amisulpride group(χ~2=149.261,P=0.000).Female patients are more prone to ischemic changes than male patients(χ~2=6.973,P=0.008),and patients over 55years old are more prone to ischemic changes than patients under 55years old(χ~2=4.419,P=0.035).CK values in clozapine group,risperidone group and amisulpride group increased slightly at the end of 2 weeks and4 weeks(F=2.629,P=0.032;F=3.673,P=0.009;F=3.293,P=0.012),and returned to normal level at the end of 6 weeks.In addition,HBDH in amisulpride group increased at weekend 2 and weekend 4 and returned to normal at weekend 6(F=3.593,P=0.012);AST in olanzapine group increased continuously until the end of the 8th week(F=6.779,P=0.000).Compared with quetiapine group,aripiprazole group and ziprasidone group,clozapine group,olanzapine group,risperidone group and amisulpride group have higher incidence of myocardial enzyme abnormality(χ~2=48.04,P=0.000).there is no significant difference in myocardial enzyme abnormality between men and women(χ~2=0.776,P=0.378),but patients aged≥55 years are prone to myocardial enzyme abnormality(χ~2=8.854,P=0.002).No matter how long or short the course of disease is,there is no significant difference in the incidence of ischemic changes and myocardial enzyme abnormalities(χ~2=0.896,P=0.573;χ~2=1.296,P=0.227).Conclusion:Seven atypical antipsychotic drugs can cause abnormal ECG changes in patients,with ischemic changes being the most common,followed by sinus tachycardia,prolonged QTc interval,sinus tachycardia relieving arrhythmia.Clozapine is most likely to cause tachycardia and ischemic changes,while amisulpride and risperidone are most likely to cause bradycardia.Ziprasidone,amisulpride and clozapine are most likely to cause QTc interval prolongation.Clozapine,olanzapine,risperidone and amisulpride have certain effects on myocardial enzymes.The effects of clozapine,risperidone and amisulpride on myocardial enzymes are reversible,while olanzapine has sustained effects on myocardial enzymes during observation.Quetiapine,aripiprazole and ziprasidone have no obvious effect on myocardial enzymes.Female patients are more prone to ECG abnormalities than male patients.Aging is an important factor for ECG and myocardial enzyme abnormalities.The course of disease has no obvious influence on ECG and myocardial enzyme.