A Comparison of Echocardiographic Findings in Young Adults with Acute Decompensated Heart Failure Due to Methamphetamine-Associated, Alcoholic, and Idiopathic Cardiomyopathy

Abstract

Background Methamphetamine is the most widespread illegal stimulant abused in the United States and the 3rd most common drug of abuse in the US after alcohol and opiates. New Mexico is one of the top ten states for methamphetamine use. No previous reports comparing echocardiographic findings of cardiomyopathy with and without a history of methamphetamine abuse in New Mexico are available. Objective To define demographic and echocardiographic characteristics of patients admitted for acute decompensated heart failure with reduced ejection fraction due to methamphetamine-associated Cardiomyopathy (MA-CMP), during index hospitalization. To compare these characteristics to patients with alcoholic cardiomyopaty (A-CMP) and Non ischemic cardiomyopathy(NICMP). Methods We performed a single institution retrospective review of medical records and analyses of echocardiographic findings in patients ≤ 55 years of age hospitalized between 2008 and 2015 who were discharged with a diagnosis of acute decompensated heart failure after their index hospitalization. Patients with ischemic CMP, severe valvular disease, or left ventricular ejection fraction > 40% were excluded. The remaining patients were divided into three groups: no substance abuse, methamphetamine abusers, and alcohol only abusers- as determined by the documented history in the medical records or urine toxicology testing. For each of the three groups in addition to demographic findings following Echocardiographic parameters were collected: Left ventricular ejection fraction (LVEF), LV end-diastolic volume (LVEDV),and LV end-systolic volume (LVESV). Results Among 225 patients who met inclusion criteria, 59 (26%) had MA-CMP, 42 (18%) A-CMP, and 124(54%) had NICMP. Multivariate linear regression analysis revealed that MA-CMP group had a lower EF of 19.93 (P Conclusions Patients with MA-CMP admitted for acute decompensated heart failure with reduced ejection fraction during index hospitalization tend to have echocardiographic findings of lower quantified LVEF, higher LVESV and LVEDV compare to patients with NICMP and alcoholic CMP related heart failure. We postulate different mechanism to explains this difference.