Abstract
Background: Methamphetamine-associated cardiomyopathy (MAC) is an increasingly diagnosed condition with poor prognosis, and there is a paucity of literature, including how MAC differs from other cardiomyopathies. This study compared the characteristics and outcomes of MAC patients with non-ischaemic cardiomyopathy controls at the current centre. Methods: Clinical profile, management, and outcomes were prospectively assessed in consecutive patients with MAC at Middlemore Hospital from 2006–2018. They were compared with randomly chosen controls with non-ischaemic dilated cardiomyopathy of a similar age group (20–65 years). Results: Both groups had 62 patients who were followed for 3.0 ± 2.9 years. The MAC patients were younger, with a higher proportion of Maori ethnicity, unemployment and cardiogenic shock during index admission, and a lower proportion of Pacific ethnicity, cardiovascular risk factors, and atrial fibrillation. The MAC patients also had higher peak N-terminal pro-B-type natriuretic peptide (NT-proBNP), lower ejection fraction, and lower attendance rate to outpatient appointments. There was no index admission mortality in either group. The MAC patients had higher mortality and a trend to higher heart failure re-admissions rates during follow-up. Amongst MAC patients, baseline left ventricular end diastolic diameter and failure of improvement in right ventricular systolic function by one category during follow-up were independent predictors of mortality, while failure of improvement of left ventricular ejection fraction by one category predicted heart failure readmission. Conclusions: The MAC patients were younger but sicker on presentation, with higher mortality and trend towards higher heart failure readmission rates during medium-term follow-up than controls. Adherence to therapy and attendance to appointments may improve cardiac systolic function over time, and reduce adverse clinical endpoints.
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