Methamphetamine‐associated cardiomyopathy ( MACM ) is an increasingly recognized disease entity in the context of a rapidly spreading methamphetamine epidemic. MACM may afflict individuals with a wide range of ages and socioeconomic backgrounds. Presentations can vary greatly and may involve several complications unique to the disease. Given the public health significance of this disease, there is a relative dearth of consensus material to guide clinicians in understanding, diagnosing, and managing MACM . This review therefore aims to: (1) describe pathologic mechanisms of methamphetamine as they pertain to the development, progression, and prognosis of MACM , and the potential to recover cardiac function; (2) summarize existing data from epidemiologic studies and case series in an effort to improve recognition and diagnosis of the disease; (3) guide short‐ and long‐term management of MACM with special attention to expected or potential sequelae of the disease; and (4) highlight pivotal unanswered questions in need of urgent investigation from a public health perspective.

Takotsubo syndrome during the COVID-19 pandemic, state-of -theart review.

Background Myocardial fibrosis is a multistep process, which results in collagen deposition in the injured muscle. Empagliflozin, a sodium-glucose cotransporter 2 inhibitor (SGLT2i), decreases cardiovascular events risk. Little is known on the effects of empagliflozin in non-diabetic patients early post myocardial infarction. Methods Fourteen non-diabetic rats underwent myocardial infarction induction, and treated or not (control)immediately after myocardial infarction by daily empagliflozin (30 mg/kg/day). We evaluated cardiac function at baseline, 2 and 4 weeks after myocardial infarction by echocardiography, and prior to sacrifice by Millar pressure–volume system. We performed histological and biochemical evaluation of fibrosis and humoral factors promoting fibrosis. Results Baseline ejection fractions were 69.9 ± 5.3% and 76.4 ± 5.4%, and dropped to final values of 40.1 ± 5.8% and 39.4 ± 5.4% in the control and empagliflozin groups, respectively (P < 0.001 vs. baseline, P > 0.05 between groups). Collagen deposition, measured as collagen volume fraction, was higher in both the scar and the remote cardiac areas of the control group 79.1 ± 6.2% and 4.6 ± 2.5% for control, and 53.8 ± 5.4% and 2.5 ± 1.3% for empagliflozin group, respectively (P < 0.05 for each). Remote cardiac muscle collagen, measured by hydroxyproline, was 4.1 ± 0.4 μg/μl and 3.6 ± 0.2 μg/μl (P = 0.07). TGF-β1 and Smad3 expression decreased by empagliflozin—18.73 ± 16.32%, 9.16 ± 5.69% and 16.32 ± 5.4%, 7.00 ± 5.28% in the control and empagliflozin groups, respectively (P < 0.05). Conclusion/interpretation Empagliflozin administered early after myocardial infarction reduce myocardial fibrosis and inhibit the TGF-β1/Smad3 fibrotic pathway, probably prior to exerting any hemodynamic or physiological effect.

A B S T R A C TBackground: The GRACE risk score is currently recommended as the major score for risk prediction on admission in patients with acute coronary syndrome (ACS). Anemia in patients with ACS adversely affects their clinical outcomes, yet hemoglobin level on admission is not included as a parameter in the GRACE score. We hypothesized that hemoglobin level on admission would improve the predictive value of the GRACE score. Methods: We retrospectively studied one-year mortality in consecutive ACS patients included in the ACSIS (acute coronary syndrome Israeli Survey) registry between the years 2008 and 2013. Patients were classified into groups according to the GRACE score -!140 or <140, and according to the hemoglobin level: severe anemia -<8 g/dl; mild anemia -8-12 g/dl; no anemia ->12 g/dl. We analyzed the incremental predictive value of admission hemoglobin levels over the GRACE score. Results: We studied 11,505 patients. The GRACE score predicted 1-year mortality with an area under the curve (ROC) of 0.68 (95% CI 0.66-0.7). When hemoglobin level on admission was incorporated into the model, the ROC increased to 0.73 (95% CI 0.71-0.75, p < 0.001). The incremental value of hemoglobin levels on admission was significant only in the low (<140) GRACE score group. Conclusions: In patients a with low GRACE score (<140), anemia on admission has additional predictive value for one-year mortality. In contrast, in patients with a high GRACE risk score, hemoglobin level on admission did not improve prediction accuracy.