B-Type Natriuretic Peptide and Troponin I as Possible Predictive Biomarkers for Cardiotoxicity Induced By Tricyclic Antidepressants and Antipsychotics Overdose

Aya Mohamed,Hoda Salah Eldin,Manal Abdel Salam

doi:10.21608/ajfm.2019.38326

Aya Mohamed, Hoda Salah Eldin + Show 1 more

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https://doi.org/10.21608/ajfm.2019.38326

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Abstract

Overdose by tricyclic antidepressants and antipsychotic drugs can lead to potentially lifethreatening cardiotoxicity. In clinical medicine, B-type natriuretic peptide (BNP) and cardiac troponin I (cTnI) are used as serum biomarkers in the diagnosis of cardiac affection. Aim: The study aimed to investigate the utility of BNP and troponin I as early predictors for TCA and antipsychotic drug -induced cardiotoxicity and correlation with severity of poisoning. Method: The study enrolled 45 patients admitted in ICU of Poison Control Center of Ain Shams University Hospitals (PCC-ASUH) with history of tricyclic antidepressants (TCA) and /or antipsychotics overdose. Collected data included sociodemographic data, manner of exposure, clinical variables, ECG changes, Poison Severity Score (PSS), serum levels of BNP and cTnI. Duration of ICU and hospital stay, and outcome were also noted. Results: In contrast to cTnI level, BNP level was significantly higher in cardiotoxicity group. Mean BNP level correlated with ECG and blood pressure changes. Biomarkers levels were nonsignificantly correlated with PSS, total hospital stay &ICU stay. PSS had low sensitivity and accuracy for prediction of cardiotoxicity. Both BNP and cTnI showed at specific cut off point showed 100% specificity with sensitivity of 53.13% & 25.0% respectively Conclusion: Although unsuitable for screening purposes, BNP surpassed cTnI as a useful tool for the diagnosis of cardiotoxicity due to overdose by tricyclic antidepressants and antipsychotic drugs

Highlights

Accidental and intentional drug overdoses constitute a significant cause of morbidity, mortality, and increased health care cost worldwide
Studies have shown that tricyclic antidepressants (TCA) directly decrease myocardial contractility in a dose dependent manner and cause peripheral vasodilatation by antagonism of peripheral alpha-1 adrenergic receptors resulting in refractory hypotension (Pierog et al, 2009; Tarek et al.,2016; Sabah et al, 2017).Antipsychotics were implicated in other cardiac complications including myocarditis,cardiomyopathy and left ventricular dysfunction with sometimes fatal effect (Curto et al.,2015)
By the end of the study, antipsychotics overdosed cases outnumbered those overdosed by TCA: constituting 75.56% of total number of cases

Summary

Introduction

Accidental and intentional drug overdoses constitute a significant cause of morbidity, mortality, and increased health care cost worldwide. Clinical effects of tricyclic antidepressants and antipsychotic drugs overdose can lead to potentially life-threatening neurological and cardiac complications (Borg et al, 2016). Both tricyclic antidepressants and antipsychotic drugs can significantly induce distinct cardiotoxicity through multiple and sometimes divergent effects on the cardiovascular system; both are known to increase the risk of potentially lifethreatening arrhythmias and sudden cardiac death (SCD). These proarrhythmic effects have been linked to prolongation of QT interval of the electrocardiogram (ECG). Studies have shown that TCAs directly decrease myocardial contractility in a dose dependent manner and cause peripheral vasodilatation by antagonism of peripheral alpha-1 adrenergic receptors resulting in refractory hypotension (Pierog et al, 2009; Tarek et al.,2016; Sabah et al, 2017).Antipsychotics were implicated in other cardiac complications including myocarditis ,cardiomyopathy and left ventricular dysfunction with sometimes fatal effect (Curto et al.,2015)

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