title: Values of using QTc and N-terminal fragment of B-type natriuretic peptide as markers for early detection of acute antipsychotic drugs-induced cardiotoxicity.
abstract: We aimed at studying the acute cardiotoxicity of the most commonly used antipsychotics in Egypt using QTc interval and NT-proBNP as markers for the early detection of such cases. Eighty-two admitted patients, at El-Minia PCC (period from 1-7-2005 to 30-6-2010), were classified into 3 groups: I: acute thioridazine overdose (n = 28), II: acute pimozide overdose (n = 23), and III: acute clozapine overdose (n = 31). Patients were investigated for NT-proBNP level and QTc on admission (day 0) and after 24 h (day 1). All the studied drugs had the ability to induce cardiotoxicity in the form of hypotension and dysrhythmias. Thioridazine and pimozide had potentially serious cardiotoxic effects than clozapine. NT-proBNP levels were elevated significantly in all groups on days 0 and 1 when compared with the reference value and a significant decrease in the same parameter on day 1 when compared with that of day 0 within the same group. QTc showed a significant prolongation in all studied groups on days 0 and 1, and there was a significant shortening of QTc on day 1 when compared with that of day 0 within the same group. A significant positive correlation of NT-proBNP level elevation with QTc prolongation was reported in all groups on days 0 and 1. Serious dysrhythmias were associated with QTc prolongation greater than 500 ms. And it was concluded that NT-proBNP, in adjunction with QTc measurement, may be a valuable and sensitive laboratory biomarker to predict cardiotoxicity of antipsychotic overdose. Larger multicenter studies are still needed to verify this possible relationship.
authors.affiliation: Department of Forensic Medicne and Clinical Toxicology, Faculty of Medicine, El-Minia University, Egypt. mohamedabdelazeem_khalaf@yahoo.com
authors.forename: Mohamed A M
authors.initials: MA
authors.lastname: Khalaf
authors.forename: Tarek M
authors.initials: TM
authors.lastname: Abdelrahman
authors.forename: Mohamed F
authors.initials: MF
authors.lastname: Abbas
mesh_terms: D000293:Adolescent; D000328:Adult; D014150:Antipsychotic Agents / Q000506:poisoning*; D001145:Arrhythmias, Cardiac / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis* / Q000503:physiopathology; D015415:Biomarkers / Q000097:blood; D016903:Drug Monitoring / Q000379:methods*; D062787:Drug Overdose; D042241:Early Diagnosis; D004534:Egypt; D004562:Electrocardiography; D005260:Female; D006329:Heart Conduction System / Q000187:drug effects* / Q000503:physiopathology; D006801:Humans; D007022:Hypotension / Q000097:blood / Q000139:chemically induced / Q000175:diagnosis* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D010446:Peptide Fragments / Q000097:blood*; D011237:Predictive Value of Tests; D013997:Time Factors; D055815:Young Adult
chemical_list: D014150:Antipsychotic Agents; D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain