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Clinical and echocardiographic outcomes in heart failure associated with methamphetamine use and cessation
  1. Harpreet Singh Bhatia,
  2. Marin Nishimura,
  3. Stephen Dickson,
  4. Eric Adler,
  5. Barry Greenberg,
  6. Isac C Thomas
  1. Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, La Jolla, California, USA
  1. Correspondence to Dr Isac C Thomas, Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, La Jolla, CA 92093-0021, USA; icthomas{at}health.ucsd.edu

Abstract

Objective Methamphetamine use is associated with systolic dysfunction, pulmonary arterial hypertension and may also be associated with diastolic dysfunction. The impact of methamphetamine cessation on methamphetamine-associated heart failure (MethHF) remains poorly characterised. We aimed to longitudinally characterise methamphetamine-associated heart failure patients with reduced (METHrEF) and preserved (METHpEF) left ventricular ejection fraction (EF), and evaluate the relationship between methamphetamine cessation and clinical outcomes.

Methods We performed a retrospective cohort study, and reviewed medical records of patients with METHrEF, METHpEF and heart failure controls without methamphetamine use. Echocardiographic variables were recorded for up to 12 months, with clinical follow-up extending to 24 months.

Results Among METHrEF patients (n=28, mean age 51±9 years, 82.1% male), cessation was associated with improvement in EF (+10.6±13.1%, p=0.009) and fewer heart failure admissions per year compared with continued use (median 0.0, IQR 0.0–1.0 vs median 2.0, IQR 1.0–3.0, p=0.039). METHpEF patients (n=28, mean age 50±8 years, 60.7% male) had higher baseline right ventricular systolic pressure (median 53.44, IQR 43.70-84.00 vs median 36.64, IQR 29.44-45.95, p=0.011), and lower lateral E/E’ ratio (8.1±3.6 vs 11.2±4., p<0.01) compared with controls (n=32). Significant improvements in echocardiographic parameters and clinical outcomes were not observed following cessation in this group.

Conclusions METHrEF patients who cease methamphetamine use have significant improvement in left ventricular systolic function and fewer heart failure admissions, suggesting that METHrEF may be reversible. Echocardiographic parameters suggest that some patients with METHpEF may have pulmonary hypertension in the absence of overt signs of left ventricular diastolic dysfunction, but additional study is needed to characterise this patient cohort.

  • echocardiography
  • heart failure
  • heart failure with preserved ejection fraction
  • heart failure with reduced ejection fraction
  • epidemiology
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Footnotes

  • Twitter @hsbhatia

  • Contributors HB, MN and IT all contributed to the planning, data collection, analysis and manuscript preparation for this study. SD, BG and EA all contributed to manuscript preparation. IT is responsible for the overall content as guarantor. The corresponding author has the right to grant on behalf of all authors and does grant on behalf of all authors, an exclusive license (or non-exclusive for government employees) on a worldwide basis to the BMJ Publishing Group Ltd (BMJPGL) and its licensees to permit this article (if accepted) to be published in HEART editions and any other BMJPGL products to exploit all subsidiary rights.

  • Funding This study was partially supported by the National Institutes of Health, Grant UL1TR001442 of CTSA.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval The study protocol was approved by the Institutional Review Board of the University of California, San Diego.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. Not applicable.

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