Clinical and echocardiographic outcomes in heart failure associated with methamphetamine use and cessation

Correspondence to Dr Isac C Thomas, Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, La Jolla, CA 92093-0021, USA; [email protected]

Introduction

Use of methamphetamines is a growing public health concern as methamphetamines and amphetamine-containing substances have become increasingly prevalent worldwide.¹ Many cardiovascular effects associated with methamphetamine use have been reported, including a long-documented association between methamphetamine use and heart failure (HF).^1–5 Proposed mechanisms related to cardiovascular complications include an increased catecholamine state leading to hypertension and tachycardia, coronary vasospasm and ischaemia, increased reactive oxygen species and direct myocardial toxicity.^{1 2}

Many forms of cardiomyopathy have been reported with methamphetamine use, including ischaemic cardiomyopathy, hypertrophic cardiomyopathy and multiple types of stress cardiomyopathies.² However, methamphetamine use is most commonly associated with a dilated cardiomyopathy^{3 4 6 7} with reduced left ventricular (LV) ejection fraction (EF)^{8 9} and increased left ventricular and atrial dilation.^{6 10 11} In small studies, cessation of methamphetamine use has been associated with improvement in EF,^{5 11} New York Heart Association (NYHA) class and combined mortality and HF hospitalisation.¹¹

Pulmonary arterial hypertension (PAH) has also been associated with methamphetamine use, predominantly among female patients.¹⁰ Thus, many patients with elevated pulmonary pressure in the absence of left ventricular systolic dysfunction are often presumed to have methamphetamine-associated PAH. However, left ventricular diastolic dysfunction may also be present as a consequence of chronic methamphetamine use due to its effects on systemic haemodynamics. Prior studies have reported evidence of diastolic dysfunction with methamphetamine use, predominantly in the setting of systolic dysfunction^{6 7} as well as in patients with PAH.¹⁰ The association of methamphetamine use with diastolic dysfunction among patients with preserved LVEF has not been well-studied.

In this study, we sought to longitudinally characterise patients with methamphetamine-associated heart failure (MethHF) in comparison with patients with HF unrelated to methamphetamine use. We characterise those with reduced ejection fraction (METHrEF), the most recognised form of HF associated with methamphetamine use, and assess the association of methamphetamine cessation with echocardiographic and clinical outcomes. Additionally, we separately characterise those with preserved ejection fraction (METHpEF) and evaluate the association of methamphetamine use and cessation with diastolic function.

Methods

Study design

We performed a retrospective cohort study at...