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(Circulation. 1995;91:1619-1623.)
© 1995 American Heart Association, Inc.

Articles

Evaluation of Myocardial Cell Damage by In-111-Monoclonal Antimyosin Antibodies in Patients Under Chronic Tricyclic Antidepressant Drug Treatment

Vicens Martí, MD, PhD; Manel Ballester, MD, PhD; Claudi Udina, MD, PhD; Ignasi Carrió, MD, PhD; Enric Alvarez, MD, PhD; Damià Obrador, MD, PhD; Guillem Pons-Lladó, MD

From the Department of Cardiology (V.M., M.B., D.O., G.P.-L.), Service of Psychiatry (C.U., E.A.) and Unit of Nuclear Medicine (I.C.), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.

Background The capability of chronic tricyclic antidepressant drug (TAD) treatment to elicit myocardial damage has been a subject of debate. Lack of an adequate noninvasive method to detect such damage has prevented an in-depth study.

Methods and Results A prospective study with In-111-monoclonal antimyosin antibodies was undertaken in a series of 21 young patients with major depression on TADs and a control group of 19 healthy subjects. A heart-to-lung ratio (HLR) of antimyosin uptake was used to discriminate normal from abnormal scans. HLR in healthy subjects was 1.39±0.08. Patients on imipramine (HLR, 1.41±0.09) or clomipramine (HLR, 1.44±0.06) showed normal studies. Those under amitriptyline had a higher HLR (1.58±0.12) compared with nonamitriptyline or normal groups (P<.05). None of the 15 patients on imipramine or clomipramine showed abnormal HLR, while 3 of 6 on amitriptyline did (P<.01). In these 3 patients, uptake decreased or disappeared after drug withdrawal. Ejection fraction was normal in every patient.

Conclusions Monoclonal antimyosin antibody studies are normal in imipramine- and clomipramine-treated patients. Antibody uptake in those under amitriptyline treatment, which disappears after drug withdrawal, would suggest early evidence of myocardial toxicity.

Key Words: drug interactions • nuclear medicine • cardiomyopathy • clomipramine • imipramine • amitriptyline • antibodies

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