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Methamphetamine‐associated cardiomyopathy: patterns and predictors of recovery
Author(s) -
Voskoboinik A.,
Ihle J. F.,
Bloom J. E.,
Kaye D. M.
Publication year - 2016
Publication title -
internal medicine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.596
H-Index - 70
eISSN - 1445-5994
pISSN - 1444-0903
DOI - 10.1111/imj.13050
Subject(s) - medicine , ejection fraction , cardiology , cardiomyopathy , inotrope , myocardial fibrosis , cardiac magnetic resonance imaging , heart failure , methamphetamine , magnetic resonance imaging , radiology
Background Methamphetamine abuse is a growing public health problem, and increasing numbers of patients are admitted with methamphetamine‐associated cardiomyopathy ( MAC ). Aim We sought to characterise the patterns of this disease and identify predictors of recovery. Methods We retrospectively studied consecutive patients diagnosed with MAC between January 2006 and July 2015. Results We identified 20 patients (14 males, 6 females) with mean age 35 ± 9 years. Most had very severe systolic dysfunction (mean left ventricular ejection fraction (LVEF) 19.7 ± 11.4%) at presentation with 14 requiring inotropes and 5 requiring mechanical support. The pattern of systolic dysfunction was global in 14 patients, while 6 patients had a ‘reverse Takotsubo’ (RT) pattern with severely hypokinetic basal‐mid segments and apical preservation. RT patients were predominantly female, had a short history of methamphetamine abuse and had higher cardiac enzyme levels. Patients with global dysfunction tended to have mid‐wall fibrosis on cardiac magnetic resonance imaging. On follow‐up transthoracic echocardiography, 6 out of 19 (32%) had normalisation of LVEF ( LVEF ≥ 50%) within 6 weeks. Smaller left ventricular and left atrial size, shorter duration of methamphetamine use and RT pattern appeared to predict early recovery. Conclusion A subset of MAC patients, particularly those with a RT pattern and lesser ventricular dilatation have the potential for early recovery of ventricular function. By contrast, those with evidence of myocardial fibrosis and ventricular enlargement have limited scope for recovery.