Impaired Global and Regional Peak Systolic Strain and Myocardial Work in Young Adults With Bipolar Disorder

Background: Patients with bipolar disorder (BD) have a high risk of heart failure. Therefore, cardiac dysfunction in these patients must be detected early to prevent heart failure. Here, we evaluated cardiac systolic function in young adults with BD by using novel measures, global and regional peak systolic strain and myocardial work, which were measured using 2-dimensional (2D) speckle-tracking echocardiography and the American Heart Association 17-segment polar map. Methods: This study included 160 individuals, comprising 106 patients with BD and 54 individuals without psychiatric disorders (ages 20–45 years), who underwent 2D speckle-tracking echocardiography. Left ventricular (LV) peak systolic strain and myocardial work were measured following the guidelines and technique recommendations of the American Society of Echocardiography and European Association of Cardiovascular Imaging. Results: For individuals with preserved ejection fraction, the BD group exhibited worse performance on LV global longitudinal strain (Cohen's d = 1.08, p < .001), LV global work index (Cohen's d = 0.49, p = .019), LV global constructive work (Cohen's d = 0.81, p < .001), and LV global wasted work (Cohen's d = 0.11, p = .048) than the group without psychiatric disorders. Peak systolic strain and myocardial work were impaired in multiple LV segments, which involved perfusion territories of 3 major coronary arteries. Conclusions: Our findings suggest that peak systolic strain and myocardial work are extensively impaired across LV segments in young adults with BD. Future studies should explore the pathways that link coronary vascular dysfunction to abnormal myocardial contractility in patients with BD. © 2025 Society of Biological Psychiatry