Clinical Characteristics and Management of Methamphetamine‐Associated Cardiomyopathy: State‐of‐the‐Art Review

Reddy, Pavan; Ng, Tien M. H.; Oh, Esther E.; Moady, Gassan; Elkayam, Uri

doi:10.1161/jaha.120.016704

Cited by 50 publications

(50 citation statements)

References 82 publications

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“…Autopsies obtained from chronic methamphetamine users showed cardiac fibrosis and necrosis findings that were directly proportional to the duration and frequency of drug use. These chronic structural changes likely increased the risk of ventricular arrhythmia due to electrical conduction abnormalities of the heart [ 1 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Methamphetamine activates the sympathetic system, resulting in tachycardia, hypertension, vasospasm/vasoconstriction, and myocardial wall stress or ischemia [ 1 ]. The exact prevalence of methamphetamine associated cardiomyopathy is unknown; however, the prevalence is on an incline due to increased drug usage.…”

Section: Introductionmentioning

confidence: 99%

“…Additional specific details such as wall motion, wall thickness, and chamber size have been correlated to clinical conditions. Methamphetamine associated cardiomyopathy has been reported to have typical echocardiographic findings of dilated cardiomyopathy with reduced left ventricular systolic function and cardiac chamber enlargement [ 1 ]. Many overlapping features may be seen on echocardiograms from the various etiologies of cardiomyopathy, such as ischemic heart disease [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

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Echocardiographic Findings in Heart Failure Patients With Methamphetamine Use: A Case-Control Study

Jariwal¹,

Narang²,

Raza³

et al. 2021

Cureus

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BackgroundMethamphetamine use is associated with cardiovascular disease and significant morbidity and mortality. There is only one previous study performed on echocardiographic parameters in patients with methamphetamine cardiomyopathy. MethodsWe performed a retrospective review of medical records in a county hospital in Southern California with a high population of methamphetamine users. We reviewed medical records and echocardiogram findings in patients seen in our institution from November 2019 to November 2020 who had cardiomyopathy with and without methamphetamine use. We excluded patients who either left the hospital or expired before appropriate assessment. We divided our patient population into a case group (methamphetamine users) and a control group (non-methamphetamine users) to study and compare their echocardiographic parameters. ResultsCase group included a total of 254 patients and control group included 268 patients. Majority of the patient population were males -178 (70%) and 180 (67%) in the case and control group respectively. Age was found to be statistically significant with the younger population in the case group (p = 0.0000). Our analysis revealed statistically significant difference in methamphetamine users compared to non-users in regards to left ventricle ejection fraction (33.65% ± 18.02 vs. 41.55% ± 15.61, p=0.0000), left ventricle mass index (122.49 grams/m 2 ± 40.66 vs. 108.62 grams/m 2 ± 32.82, p=0.0000), left ventricle end diastolic volume index (85.91 mL/m 2 ± 37.40 vs. 72.44 mL/m 2 ± 25.44; p=0.0000) and marginally significant right ventricle systolic pressure (42.29mmHg ± 17.53 vs. 39.59mmHg ± 15.61; p=0.0540) ConclusionOur results indicated that methamphetamine users had echocardiogram findings with decreased ejection fraction and increased left ventricular mass index, end-diastolic volume index, and right ventricular systolic pressure consistent with worse dilated cardiomyopathy comparison to non-users.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Echocardiographic Findings in Heart Failure Patients With Methamphetamine Use: A Case-Control Study

Jariwal¹,

Narang²,

Raza³

et al. 2021

Cureus

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“…2021 ). Endogenous and synthetic catecholamines are also well recognized CV toxicants at high levels of exposure, and direct and indirect cardiomyocyte injury are important mediators of systolic dysfunction, such as in methamphetamine-associated cardiomyopathy ( Reddy et al. 2020 ).…”

Section: Descriptions Of the Kcs Of CV Toxicantsmentioning

confidence: 99%

Key Characteristics of Cardiovascular Toxicants

Lind¹,

Araujo

Barchowsky

et al. 2021

Environ Health Perspect

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Background: The concept of chemical agents having properties that confer potential hazard called key characteristics (KCs) was first developed to identify carcinogenic hazards. Identification of KCs of cardiovascular (CV) toxicants could facilitate the systematic assessment of CV hazards and understanding of assay and data gaps associated with current approaches. Objectives: We sought to develop a consensus-based synthesis of scientific evidence on the KCs of chemical and nonchemical agents known to cause CV toxicity along with methods to measure them. Methods: An expert working group was convened to discuss mechanisms associated with CV toxicity. Results: The group identified 12 KCs of CV toxicants, defined as exogenous agents that adversely interfere with function of the CV system. The KCs were organized into those primarily affecting cardiac tissue (numbers 1–4 below), the vascular system (5–7), or both (8–12), as follows: 1) impairs regulation of cardiac excitability, 2) impairs cardiac contractility and relaxation, 3) induces cardiomyocyte injury and death, 4) induces proliferation of valve stroma, 5) impacts endothelial and vascular function, 6) alters hemostasis, 7) causes dyslipidemia, 8) impairs mitochondrial function, 9) modifies autonomic nervous system activity, 10) induces oxidative stress, 11) causes inflammation, and 12) alters hormone signaling. Discussion: These 12 KCs can be used to help identify pharmaceuticals and environmental pollutants as CV toxicants, as well as to better understand the mechanistic underpinnings of their toxicity. For example, evidence exists that fine particulate matter [PM in aerodynamic diameter ( )] air pollution, arsenic, anthracycline drugs, and other exogenous chemicals possess one or more of the described KCs. In conclusion, the KCs could be used to identify potential CV toxicants and to define a set of test methods to evaluate CV toxicity in a more comprehensive and standardized manner than current approaches. https://doi.org/10.1289/EHP9321

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“…Coined "twin epidemics" (13), this phenomenon has now been studied in substance use disorder (SUD) treatment samples (10,11,13), a cross-sectional study of mid-western NMPOU's ( 14) and nationally-representative samples (12,15), but has not been studied longitudinally among those using opioids. Increased methamphetamine use raises considerable concern as it is associated with a litany of harms; including, among others, dental issues (16,17), cardiac abnormalities (18,19), and transmission of infectious diseases, such as HIV and hepatitis C via sharing of infected pipes and injection implements, as well as engagement in risky sex (20)(21)(22)(23). Methamphetamine use is not novel, especially in rural areas of the U.S. (24,25) and among those using drugs to enhance sex ("chemsex") (26,27); however, there is growing body of evidence that use is increasing in new populations of established people who use drugs (PWUD), and people using opioids in particular (12,14).…”

Section: Introductionmentioning

confidence: 99%

Recent Increase in Methamphetamine Use in a Cohort of Rural People Who Use Drugs: Further Evidence for the Emergence of Twin Epidemics

et al. 2022

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Appalachian Kentucky was at the epicenter of the prescription opioid epidemic in the early 2000's. As we enter the third decade of the epidemic, patterns have begun to emerge as people who use drugs (PWUD) transition from use of opioids to other drugs. The purpose of this analysis was to examine longitudinal changes in methamphetamine use in an ongoing cohort of rural people who use drugs (PWUD) in Appalachian Kentucky. All but five of the cohort participants (N = 503) reported nonmedical prescription opioid use (NMPOU) at baseline and those 498 are included in this longitudinal analysis encompassing eight waves of data (2008–2020). Past 6-month use of methamphetamine was the dependent variable. Given the correlated nature of the data, mixed effects logistic regression was utilized to examine changes in methamphetamine use over time. Significant increases in methamphetamine use were observed over the past decade in this cohort of PWUD, especially in recent years (2017–2020). Prevalence of recent use at baseline and each of the follow-up visits was as follows: 9.4, 5.6, 5.0, 5.4, 8.1, 6.8, 6.9, and 33.1%, respectively (p < 0.001). On the contrary, significant reductions in NMPO and heroin use were observed in the same time period. The odds of methamphetamine use at the most recent visit were 25.8 times greater than at baseline (95% CI: 14.9, 44.6) and 52.6% of those reporting methamphetamine use reported injecting the drug. These results provide further evidence of “twin epidemics” of methamphetamine use among NMPOU. While problematic on several fronts, of particular concern is the lack of effective treatment options for methamphetamine use disorder. As policies around the opioid epidemic continue to evolve, particular attention should be paid to the surge in stimulant use in opioid-endemic areas.

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Clinical Characteristics and Management of Methamphetamine‐Associated Cardiomyopathy: State‐of‐the‐Art Review

Cited by 50 publications

References 82 publications

Echocardiographic Findings in Heart Failure Patients With Methamphetamine Use: A Case-Control Study

Echocardiographic Findings in Heart Failure Patients With Methamphetamine Use: A Case-Control Study

Key Characteristics of Cardiovascular Toxicants

Recent Increase in Methamphetamine Use in a Cohort of Rural People Who Use Drugs: Further Evidence for the Emergence of Twin Epidemics

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