Clinical characteristics and outcomes of patients with P-associated cardiomyopathy (PAC) in Auckland, New Zealand

Abstract

Background: Methamphetamine or P-associated cardiomyopathy (PAC) is becoming an increasingly recognised entity. We aimed to describe the characteristics and outcome of patients with PAC presenting to Middlemore Hospital. Methods: Patients admitted with heart failure and echocardiographic evidence of cardiomyopathy between 2011 and 2014 were retrospectively identified if they had recent reported amphetamine abuse and this was thought to be the most likely cause of cardiomyopathy following investigations. Results: 15 patients were identified with a mean follow-up of 1.5 years. The mean age was 36 years with male predominance (93%) and 11/15 were of indigenous Maori ethnicity. At presentation 40% were in pulmonary oedema, 20% were in cardiogenic shock and 27% required intensive care unit (ICU) admission for inotropic support (3 patients) and mechanical ventilation (2 patients). The ECG was abnormal in 73% of patients, predominantly with T wave inversion. Baseline echocardiograms showed severe left ventricular (LV) dilation (mean LV end-diastolic dimension (LVEDD) - 6.7cm) and severe LV dysfunction (mean LVEF - 16 +/- 6%) in all patients. ACE-inhibitor, beta-blocker and spironolactone were commenced on 67% of patients. Follow-up echocardiograms on 7 patients continued to show severe LV dilation (mean LVEDD 7.2cm) and severe LV dysfunction (mean LVEF – 19 +/- 8%). Two patients (13%) died from end-stage heart failure during the follow up period. Conclusions: PAC was predominant in young indigenous Maori men in our cohort. They present with severe cardiomyopathy, often requiring ICU admission. Significant LV dysfunction persisted despite heart failure therapy and mortality is high. CSANZ NZ AbstractsHeart, Lung and CirculationVol. 23Preview Full-Text PDF