Морфометрические аспекты морфогенеза нейролептической кардиомиопатии

Abstract

Aim. Neuroleptic cardiomyopathy (NCMP) is the most serious cardiotoxic adverse effect of neuroleptics. NCPM morphogenesis at tissue and cell levels has not been investigated previously. This study examined the progression of myocardial changes throughout the stages of NCMP development. Material and methods. Using morphometric methods, myocardial changes were examined in 4 groups of diseased psychiatric patients: 1) death from non-cardiac causes, no neuroleptic treatment in anamnesis (n=10); 2) no cardiac pathology, antipsychotic therapy in anamnesis (n=12); 3) latent NCMP (n=24); 4) fatal NCMP (n=34). All groups were comparable by age and sex. The quantitative data were analysed using Statistica 6.0. Results. Cardiotoxicity of neuroleptics is manifested in a variable degree of morphological and functional myocardial changes, which reflect compensatoryadaptive, dystrophic-degenerative, and sclerotic processes at the tissue level, developing during NCMP morphogenesis. Disturbances of microcirculation and collagen synthesis in the myocardial extracellular matrix result in the decreased volume, degeneration, and atrophy of cardiomyocytes. This facilitates myocardial dysfunction progression and clinical manifestation of fatal heart failure. Conclusions. Psychopharmacological therapy is always associated with the risk of NCMP development, as a manifestation of cardiotoxicity of neuroleptics. Myocardial structural changes, identified with morphometric methods, predict the progression of myocardial dysfunction linked to cardiotoxic adverse effects of these medications.