Study Reveals Subtle Heart Muscle Dysfunction in Bipolar Disorder Patients

New study findings published by investigators in Biological Psychiatry identified subtle heart muscle abnormalities in young adults with bipolar disorder by measuring peak systolic strain and myocardial work. The study authors noted that these early cardiac issues could be a factor in the high rate of premature deaths from cardiovascular disease in individuals with bipolar disorder.^1,2

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“Because no study has previously evaluated regional peak systolic strain and regional myocardial work in patients with bipolar disorder using the American Heart Association (AHA) 17-segment model, this hypothesis-generating study was designed to identify patterns and formulate potential hypotheses for further investigation into the heart–bipolar disorder link,” Pao-Huan Chen, MD, PhD, department of psychiatry, school of medicine, college of medicine at Taipei Medical University; and department of psychiatry and psychiatric research center at Taipei Medical University Hospital, said in a news release.²

Bipolar Disorder and Cardiovascular Disease

As a severe mental illness, bipolar disorder typically presents signs and symptoms during adolescence and young adulthood, including mania and hypomania and major depressive episodes. However, symptoms in children and teens are often hard to identify, including fast mood shifts during episodes.^2,3

Previous population-based cohort studies and large-scale meta-analyses have revealed that individuals with bipolar disorder are at nearly a 2-fold higher risk of heart failure, which is marked as the main cause of premature cardiovascular mortality among individuals with bipolar disorder.^1,2

“Individuals with bipolar disorder have reduced life expectancy relative to the general population by nine to 20 years, and some of this risk may be related to increased risk for cardiovascular disease,” John Krystal, MD, editor of Biological Psychiatry, said in the news release. This study raises important questions about this risk and potential genetic links between bipolar disorder and cardiac disease, the cardiac impact of psychotropic medications and other environmental factors like diet, exercise, stress, and substance use. It will also be important to understand why women were affected to a greater extent than men."²

Study Design and Results

A total of 160 individuals were included in the study—106 individuals with bipolar disorder and 54 individuals without any psychiatric disorders. Researchers used a technique called 2-dimensional speckle-tracking echocardiography to measure left ventricular peak systolic strain and myocardial work, following guidelines from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.^1,2

“Following replication in future studies across different samples, the peak systolic strain and myocardial work indices should be incorporated into the cardiovascular assessment for patients with bipolar disorder. This assessment would provide an opportunity to identify and manage cardiac dysfunction as early as possible before the progression of heart failure, while laying a strong foundation for the development of new therapeutics to avoid heart failure and improve life expectancy,” Chen said in the news release.²

The results demonstrated that in individuals with preserved ejection fraction, the bipolar disorder group had worse outcomes on left ventricular global longitudinal strain, left ventricular global index, and left ventricular global wasted work compared with the non-psychiatric disorder group.¹

“Although there is much evidence suggesting elevated cardiovascular risk in individuals with bipolar disorder, we are still surprised by the findings that even in this young population with bipolar disorder, the myocardial dysfunction extensively involves the left ventricular segments across the perfusion territories of the three major coronary arteries,” Cheng-Yi Hsiao, MD, division of cardiology, department of internal medicine, and cardiovascular research center at Taipei Medical University Hospital, said in the news release.²

REFERENCES

1. Hsia C, Hsieh T, Lai H, et al. Impaired Global and Regional Peak Systolic Strain and Myocardial Work in Young Adults With Bipolar Disorder. Biological Psychiatry, Volume 0, Issue 0. https://www.biologicalpsychiatryjournal.com/action/showCitFormats?doi=10.1016%2Fj.biopsych.2025.06.021&pii=S0006-3223%2825%2901295-8

2. New research detects early heart dysfunction in young adults with bipolar disorder. EurekAlert! News release. August 19, 2025. Accessed August 21, 2025. https://www.eurekalert.org/news-releases/1095226

3. Mayo Clinic. Bipolar Disorder. News release. August 14, 2024. Accessed August 22, 2025. https://www.mayoclinic.org/diseases-conditions/bipolar-disorder/symptoms-causes/syc-20355955