Relation between myocardial oedema and cocaine assumption in heavy-user asymptomatic cocaine addicts

Abstract

Purpose: A great prevalence of myocardial damage was previously reported in asymptomatic cocaine addicts by cardiovascular magnetic resonance (CMR): either myocardial fibrosis (73%) was detected by late gadolinium enhancement (LGE) technique or oedema (47%) on T2-STIR images, the latter likely secondary to a recent damage (within 1 month). To evaluate the effect of drug withdrawal on myocardial oedema, we studied by CMR subjects with chronic (>1-year) cocaine addiction, before and after 1-month rehabilitation program. Methods: Twenty-five consecutive subjects were enrolled, with psychiatric diagnosis of cocaine addiction (21 men, 37±8 years) entering the rehabilitation therapy and with no history of cardiac symptoms/disease. A first CMR examination (T2-weighted STIR images and LGE technique for evaluation of myocardial oedema and fibrosis, respectively) was performed 48h after drug withdrawal (CMR-I) and a second one (CMR-II) after 1-month rehabilitation. Abstinence was monitored by urine assay for cocaine metabolites performed within two weeks before CMR-I and every 3 days. Results: Mean reported baseline dose of cocaine as 2.9 g/assumption; abstinence was confirmed in 12 subjects (48%) by urine assay. Myocardial oedema was present in 19/25 (76%) subjects at CMR-I, while it was observed at CMR-II in 13/25 (52%). At CMR-II in 11 subjects with positive urine test (44%) myocardial oedema was detected. De-novo oedema was detected in 2 other subjects (8%). Conversely, oedema disappeared at CMR-II in 8 subjects (32%), who had signs of myocardial oedema at CMR-I and respecting abstinence at urine test. Finally in 4 (16%) oedema was absent in both CMR. A good agreement was found between the results of urinary analysis and the detection of myocardial oedema in both examinations (agreement in 91% of cases, p<0.0001). Conclusions: In heavy users, cocaine assumption was tightly associated with myocardial oedema, while 1-month ascertained drug withdrawal was frequently associated with its reversal at CMR examination.