Methamphetamine-associated Cardiomyopathy Research Articles

Cardiomyopathy in Patients With Acute Ischemic Stroke and Methamphetamine Use: Relevance for Cardioembolic Stroke and Outcome.

Methamphetamine use has emerged as a major risk factor for cardiovascular and cerebrovascular disease in young adults. The aim of this study was to investigate a possible association of methamphetamine use with cardioembolic stroke. We performed a retrospective study of patients with acute ischemic stroke admitted at our medical center between 2019 and 2022. All patients were screened for methamphetamine use and cardiomyopathy, defined as left ventricular ejection fraction ≤45%. Among 938 consecutive patients, 46 (4.9%) were identified as using methamphetamine. Compared with the nonmethamphetamine group (n=892), the methamphetamine group was significantly younger (52.8±9.6 versus 69.7±15.2 years; P<0.001), included more men (78.3% versus 52.8%; P<0.001), and had a significantly higher rate of cardiomyopathy (30.4% versus 14.0%; P<0.01). They were also less likely to have a history of atrial fibrillation (8.7% versus 33.4%; P<0.01) or hyperlipidemia (28.3% versus 51.7%; P<0.01). Compared with patients with cardiomyopathy without methamphetamine use, the patients with cardiomyopathy with methamphetamine use had significantly lower left ventricular ejection fraction (26.0±9.59% versus 32.47±9.52%; P<0.01) but better functional outcome at 3 months, likely attributable to significantly younger age and fewer comorbidities. In the logistic regression model of clinical variables, methamphetamine-associated cardiomyopathy was found to be significantly associated with cardioembolic stroke (odds ratio, 1.79 [95% CI, 1.04-3.06]; P<0.05). We demonstrate that methamphetamine use is significantly associated with cardiomyopathy and cardioembolic stroke in young adults.

Risk Factors and Emergency Department Outcomes in Methamphetamine-Associated Cardiomyopathy: A Case-Control Study

BackgroundMethamphetamine-associated cardiomyopathy (MACM) is a known complication of methamphetamine use; however, risk factors and outcomes of patients with MACM are not well understood. Study ObjectivesThis study aims to identify risk factors, emergency department (ED) interventions, and outcomes for MACM. MethodsThis case-control study was conducted between 2012 and 2020 at two academic EDs. ED patients ≥18 years with an index visit that included documented methamphetamine use were included. Patients with documented MACM during follow-up (3 months–3 years) were considered cases (MACM). A control group comprised of patients with documented methamphetamine use but no known MACM was matched at a 2:1 ratio. Logistic regression was used to model risk factors for MACM. ResultsA total of 9833 patients with methamphetamine use were identified. From this, 160 MACM patients were matched to 322 controls. The mean age was 48.4 years, and 143 patients (29.7%) were female. MACM patients were more likely to be admitted on their index visit (45.6% vs. 34.8%, p = 0.021). Significant variables associated with MACM included: admission at the index visit (odds ratio [OR] 1.51), diabetes (OR 3.02), kidney disease (OR 5.47), and pulmonary disease (OR 2.39). MACM patients had more ED visits in the follow-up period (10.1 vs. 7, p = 0.009) and were admitted at a higher rate across all visits (32.5% vs. 15.4%, p = 0.009). Additionally, MACM patients had significantly longer hospital stays than controls (mean 18 additional days, p = 0.009). ConclusionPatients who developed MACM had traditional risk factors for heart failure and experienced significantly more ED visits, more hospitalizations, and longer hospital stays than matched controls.

Reverse Remodeling of Methamphetamine-Associated Cardiomyopathy: An Update on Mechanisms for Recovery

Methamphetamine (MA) use continues to rise worldwide. The adverse effects of MA on the cardiovascular system include cardiomyopathy, dysrhythmias, coronary arterial vasospasm, and atherosclerosis. Methamphetamine-associated cardiomyopathy (MACM) affects predominantly younger male patients and is responsible for an increasing proportion of heart failure emergency department visits, hospital admissions/readmissions, morbidity, and mortality. Reverse remodeling of MACM and full cardiac recovery is achievable in patients who cease using MA and remain abstinent with self-direction, cognitive behavioral therapy, brief interventions, contingency management, motivational interviewing, and residential rehabilitation. Recovery is further enhanced by the addition of an exercise program and guideline-based pharmacotherapy for heart failure, which includes β-blockers, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers or angiotensin receptor-neprilysin inhibitors, mineralocorticoid receptor antagonists, and sodium-glucose cotransporter 2 inhibitors. Alternative heart failure treatment with isosorbide dinitrate plus hydralazine, ivabradine, vericiguat, and omecamtiv mecarbil represent further adjuncts which may promote reverse remodeling. Antioxidant compounds such as coenzyme-Q10, omega-3 polyunsaturated fatty acids, resveratrol, and cannabidiol may aid in cardiac restoration. Diet changes, metformin and glucose control, stem cell therapy, melatonin, and sleep quality improvement are further steps on the road to recovery. In this article we review the cardiotoxicity of MA, pathogenesis of MACM, and evidence behind pharmacologic and lifestyle interventions to reverse its progression.

Methamphetamine-associated cardiomyopathy.

Methamphetamine-associated cardiomyopathy.

Abstract 15327: Clinical Outcomes of Methamphetamine-Associated Cardiomyopathy Compared to Ischemic Cardiomyopathy: A Single Institution Retrospective Longitudinal Study

Background: Methamphetamine-associated cardiomyopathy (MAC) leads to significant morbidity and mortality. The benefit of implantable cardioverter-defibrillator (ICD) in this population is poorly characterized. Aims: To evaluate ICD use and outcomes in patients with MAC compared to ischemic cardiomyopathy (ICM). Methods: Electronic health record (EHR) was queried for all heart failure hospitalizations using ICD-9 codes between 2011 and 2019. Patients with an EF ≤ 35% were included. The MAC cohort was derived from this population and defined by ICD-9 code or positive urine toxicology and compared to ICM cohort. Baseline characteristics and outcomes were extracted from the EHR. MACE was defined as death, ventricular tachycardia, cardiac arrest, rehospitalization, atrial fibrillation (AF) or stroke. Results: The study included 294 patients in the MAC group and 373 patients in the ICM group. MAC patients were younger (56 vs 61 years, p&lt;0.001) compared to ICM (table 1). Readmission rates for heart failure at one year were similar (13% vs 11.2%, p=ns). Significantly fewer patients with MAC had ICD for primary prevention (15.0% vs 27.9%, p&lt;0.001). Mortality and AF were lower in MAC compared to ICM, however VT (2.38% vs 5.09%, p=0.072) and cardiac arrest (6.1% vs 7.8%, p=0.408) were similar between the two groups. MACE outcomes were worse in the ICM cohort (38.3% vs 21.1%, p=0.012) than MAC. In the MAC cohort, ICD presence was associated with 56.82% incidence of MACE compared to 40.00% without ICD (OR = 1.97, CI 1.032-3.77, p = 0.040) mainly due to higher AF hospitalization (22% vs 8%, p=0.01). Conclusion: ICM patients had higher mortality and atrial fibrillation compared to MAC. ICD implantation for primary prevention was not associated with reduced mortality, however this cohort had higher AF hospitalization. We need further studies to assess the benefit of ICD in MAC.

Large Left Ventricular Thrombus in a Patient with Methamphetamine Associated Cardiomyopathy: A Case Report

The development of small or moderate size left ventricular thrombus (LVT) is a well-known complication in various cardiac conditions with the highest rate observed in acute anterior myocardial infarction and congestive heart failure (CHF) as a result of severe left ventricular (LV) systolic dysfunction, but a huge LVT that almost protrudes to the aortic valve is an exceptionally rare phenomenon.

Manage methamphetamine-associated cardiomyopathy by promoting abstinence in addition to the use of pharmacotherapies

Manage methamphetamine-associated cardiomyopathy by promoting abstinence in addition to the use of pharmacotherapies

Ethnicities of Patients Presenting with Methamphetamine Associated Cardiomyopathy at a Tertiary Hospital System in Hawaii

<h3>Purpose</h3> Methamphetamine (meth) use is now the second most used illicit substance worldwide. Methamphetamine-associated cardiomyopathy/heart failure (MethHF) is an increasingly recognized disease entity. Previous literature has showed that racial and ethnic minority populations are at higher risk for meth use. We set out to characterize the degree of burden of MethHF through the lens of ethnicity at a major metropolitan, tertiary hospital hospital system in Hawaii. <h3>Methods</h3> A retrospective chart review from 2011 to 2021 including all adult patients (≥18 years old) with positive meth urine drug screen or with prior diagnosis of meth use with and without a diagnosis of cardiomyopathy in the electronic medical record were included for analysis. They were compared to patients with heart failure from any cause as defined by a serum BNP >200, serum NT proBNP >200, or a positive history of cardiomyopathy as defined by ICD codes in the electronic medical record. <h3>Results</h3> The socio-demographics of patients presenting with MethHF are included in Table 1. 46,849 patients were included for analysis. MethHF was seen most commonly in the Native Hawaiian, Caucasian, and Filipino population with the three groups making up for 65% of the total MethHF burden. The prevalence of meth use was highest in the Caucasian population, however MethHF was seen more commonly in the Native Hawaiian population. The prevalence of MethHF in the Native Hawaiian population is more striking when compared to 2020 census data showing that only 5% of the island's population identify as such. <h3>Conclusion</h3> Our results suggest that the burden of meth use and MethHF at our institution is higher in minority populations. This study suggests that greater awareness of psychosocial factors in MethHF patients is needed to better prevent and treat this burgeoning disease.

A Comprehensive Approach to Managing Methamphetamine-Associated Cardiomyopathy.

Methamphetamines are illicit drugs of the amphetamine-type stimulant class that have been increasing in popularity, availability, and purity in recent decades. As a result, rates of methamphetamine-associated cardiomyopathy (MAC) are rising globally. MAC is associated with high rates of sudden cardiac arrest, late presentation, and poor outcomes. This review discusses the medical management of MAC, including anticipated challenges specific to methamphetamine users. Not only are patients with MAC more likely to present at a younger age and with multisystem disease than patients with cardiomyopathy of other etiologies, but there may also be significant behavioral, psychosocial, financial, and system-based challenges to providing the best medical care. An individualized treatment plan that emphasizes methamphetamine abstinence as the foundation of therapy, as well as introducing optimal heart failure therapy and providing multidisciplinary support is likely to result in optimal outcomes. Given the potential reversibility of MAC, institution of guideline-directed heart failure therapy and patient support for adherence to therapy and abstinence from methamphetamines should be energetically pursued.

Cardiovascular magnetic resonance imaging characteristics in patients with methamphetamine-associated cardiomyopathy

BackgroundMethamphetamine-associated cardiomyopathy (MA-CMP) is an increasingly recognised aetiology of cardiomyopathy. Cardiovascular magnetic resonance (CMR) is a specialised cardiac imaging modality commonly used in assessment of cardiomyopathy. We aimed to identify specific CMR features associated with MA-CMP.MethodsA retrospective cohort study of CMR scans was performed in a single centre between January 2015 and December 2020. Thirty patients with MA-CMP who had undergone CMR were identified. MA-CMP was defined as those with a history of significant methamphetamine use hospitalised with acute decompensated heart failure (other causes of cardiomyopathy excluded). A retrospective analysis of index admission CMRs was performed. All studies were performed on a 1.5 T CMR scanner.ResultsThe mean age of MA-CMP patients was 43.7 ± 7.5 years, and 86.7% were male. The mean left ventricular (LV) volume obtained in this cohort was consistent with severe LV dilatation (LV end-diastolic volume (334 ± 99 ml); LV end-systolic volume: 269 ± 98 ml), whilst the right ventricular (RV) volume indicated moderate-to-severe dilatation (RV end-diastolic volume: 272 ± 91 ml; RV end-systolic volume: 173 ± 82 ml). Mean LV ejection fraction (20.9 ± 9.2%) indicated severe LV dysfunction, with moderate-to-severe RV dysfunction also detected (RV ejection fraction: 29.4 ± 13.4%). 22 patients (73.3%) had myocardial late gadolinium enhancement (LGE), of which 59.1% were located in the mid-wall, with all of these involving the interventricular septum. 22.7% displayed localised regions of sub-endocardial LGE in a variety of locations, and 18.2% had transmural regions of LGE that were located in the inferior and inferolateral segments. 6 patients (20%) had intracardiac thrombus (4 LV, 2 both LV and RV).ConclusionMA-CMP was associated with severe biventricular dilatation and dysfunction, with a high prevalence of intraventricular thrombus. This cohort study highlights that MA-CMP patients have a high prevalence of CMR findings.

Characteristics of Methamphetamine-associated Cardiomyopathy and the Impact of Methamphetamine Use on Cardiac Dysfunction

Methamphetamine-associated cardiomyopathy (MACM) in an increasingly prevalent disease yet presenting clinical characteristics have not been well studied. We studied consecutive patients with MACM presenting between June 2018 and March 2020 who were interviewed for drug use and medical history. We retrospectively identified an age- and gender-matched cohort of Non-MACM (NMACM) patients and compared clinical characteristics. 140 patients (70 MACM and 70 NMACM) were studied. MACM patients were young (49.6 ± 10 years) and predominantly male (94%). Compared to NMACM, MACM patients were more likely to be Caucasian (21% vs 6%, p=0.007) and homeless (47% vs 7%, p=0.001). MACM was characterized by lower left ventricular ejection fraction (EF) (p <0.001) and greater LV end diastolic volume (LVEDV) (p=0.024). Right ventricular (RV) dilation was present more often (p=s0.001) and was more often severe (p=0.03). Among MACM cases, half of the cohort developed MACM within 5 years of starting MA (18% within 1 year). There was no apparent relationship between frequency or amount of MA used weekly with time until heart failure onset. Drug use patterns were not clearly related to the degree of LV structural change however there were more consistent, significant associations with RV and right atrial (RA) size parameters. In conclusion, patients with MACM have more severe myocardial impairment with lower EF, greater LVEDV and RV dilation. Drug use patterns do not clearly impact degree of LV structural changes by echocardiography however may be related to RV and RA size.

Methamphetamine induces cardiomyopathy by Sigmar1 inhibition-dependent impairment of mitochondrial dynamics and function

Methamphetamine-associated cardiomyopathy is the leading cause of death linked with illicit drug use. Here we show that Sigmar1 is a therapeutic target for methamphetamine-associated cardiomyopathy and defined the molecular mechanisms using autopsy samples of human hearts, and a mouse model of “binge and crash” methamphetamine administration. Sigmar1 expression is significantly decreased in the hearts of human methamphetamine users and those of “binge and crash” methamphetamine-treated mice. The hearts of methamphetamine users also show signs of cardiomyopathy, including cellular injury, fibrosis, and enlargement of the heart. In addition, mice expose to “binge and crash” methamphetamine develop cardiac hypertrophy, fibrotic remodeling, and mitochondrial dysfunction leading to contractile dysfunction. Methamphetamine treatment inhibits Sigmar1, resulting in inactivation of the cAMP response element-binding protein (CREB), decreased expression of mitochondrial fission 1 protein (FIS1), and ultimately alteration of mitochondrial dynamics and function. Therefore, Sigmar1 is a viable therapeutic agent for protection against methamphetamine-associated cardiomyopathy.

A Prospective Evaluation of Clinical Characteristics of Methamphetamine-associated Cardiomyopathy (MACM) in Comparison to a Matched-cohort with Non-methamphetamine Non-ischemic Cardiomyopathy

Background With globally increasing rates of methamphetamine (MA) abuse, there is a rising prevalence of methamphetamine-associated cardiomyopathy (MACM). The condition, however, is poorly characterized, leaving clinicians with little data to guide diagnosis and management. Purpose To compare clinical characteristics of prospectively encountered patients with MACM to those with non-MA non-ischemic cardiomyopathy (NMACM). Methods Consecutive patients with MACM confirmed by history presenting to Los Angeles County (LAC)+USC Medical Center between Jun 2018 and March 2020 were interviewed and studied. We retrospectively identified an age- and gender-matched cohort of NMACM and compared demographic, laboratory, and echocardiographic data between the two groups. Results 140 patients (70 MACM and 70 NMACM) were included. Mean age was similar (49.6±10 vs 48.2±10.5 years, p=0.45) and 94% of patients were male. Patients were predominantly Hispanic in both groups (51% vs 61%, p=0.232) with a greater proportion of Caucasians in the MACM group (21% vs 6%, p=0.007). Significantly more patients with MACM were homeless (47% vs 7%, p=0.001). 20% of MACM patients were college educated. The mean and median duration of MA use prior to a diagnosis of heart failure was 9.8 and 5.5 years, respectively. Two-thirds of MACM patients reported current MA use. MACM compared to NMACM was characterized by lower left ventricular ejection fraction (LVEF) [20% vs 26%, p Conclusion Compared to an age and gender matched cohort of NMACM, prospectively identified patients with MACM had a high incidence of homelessness and significantly more severe myocardial insult with greater degree of LV and RV dilatation and depression of LV function. Frequency or amount of MA use did not appear to be associated with severity of MACM.

Clinical Characteristics and Outcomes of Methamphetamine Associated Cardiomyopathy Patients Presenting with Cardiogenic Shock

Introduction: with the increasing use of methamphetamine in the United States, there is a growing prevalence of methamphetamine associated cardiomyopathy (MAC), including presentation with heart failure and cardiogenic shock. Clinical characteristics and outcomes of patients with MAC presenting with cardiogenic shock have not been previously described. compared to other non-ischemic cardiomyopathy (NICM) patients who presented with cardiogenic shock. Methods: In this retrospective case-control study of 140 patients with NICM admitted to our institution from January 1, 2015 to December 31, 2018, we compared 41 patients with MAC to 99 with non-MAC NICM using univariate and multivariate regressions including Cox proportional hazards. Results: All baseline characteristics and inotrope use and dosing are summarized in Table 1. Patients with MAC had an average age of 49.7 years vs 61.3 years in NICM group (p

Methamphetamine Induced Cardiomyopathy

Unfortunately, 35 million people worldwide suffer from drug use disorder while only one in seven people receive treatment. The health impacts combined with the socioeconomic burden of drug abuse are too numerous to count. It is well known that all organ systems are adversely affected by drug use including but not limited to the cardiovascular, respiratory, neurological, and renal. We will focus our attention on the effects of Methamphetamines on the cardiovascular system. Methamphetamines are known to be highly addictive stimulants with significant cardiovascular implications. We have gathered information from the literature available on methamphetamine-associated cardiomyopathy (MACM) and will discuss a case of a 58-year-old male, with no past medical history, who presented with dyspnea secondary to MACM.

Comparison of Clinical Characteristics and Outcomes of Patients With Reversible Versus Persistent Methamphetamine-Associated Cardiomyopathy

Anecdotal cases of reversible methamphetamine-associated cardiomyopathy (rMAC) have been reported, but not well understood. This study sought to determine the clinical characteristics, outcomes and predictors of reversibility among patients with rMAC as compared with patients with persistent MAC (pMAC). We retrospectively studied adult MAC patients with left ventricular ejection fraction (LVEF) ≤40% at a single center between 2004 and 2018. rMAC was defined as increase in LVEF by ≥20 points or to ≥50%. Those with persistent LVEF ≤40% constituted the pMAC group. 357 MAC cases were identified: 250 patients had pMAC and 107 had rMAC. After a median follow-up of 45 months (interquartile range 27 to 70), LVEF increased by 28.3 ± 6.9% in rMAC (p <0.001), whereas it was unchanged in pMAC (Δ: -0.5 ± 8.7%, p = 0.350). Heart failure hospitalizations and New York Heart Association Class III/IV heart failure were both significantly reduced for rMAC than the pMAC group. All-cause mortality was 21.6% overall, 28% in pMAC and 6.5% in the rMAC group (p <0.001). Kaplan-Meier survival curves demonstrated significantly higher cumulative survival for rMAC (Log Rank p <0.001). Multivariable logistic regression identified MA cessation (odds ratio/OR: 4.23, 95% confidence interval/CI: 2.47 to 7.38, p <0.001) and baseline right ventricular end systolic area (OR: 0.92, 95% CI: 0.87 to 0.97, p = 0.001) as strongly predictive of MAC reversal. In conclusion, MAC reversal is not uncommon and is associated with significant clinical improvement including reduced mortality. It can be facilitated by MA cessation when the cardiac chambers, especially the right ventricle, are not severely dilated.

Clinical Differences between Methamphetamine and Non-Methamphetamine Associated Non-Ischemic Dilated Cardiomyopathy

Background Methamphetamine associated cardiomyopathy (MACM) is an increasingly recognized form of dilated cardiomyopathy around the globe which remains poorly characterized. Purpose To compare the clinical characteristics of MACM to those of non-MA associated dilated CM (NMACM). Methods Consecutive patients with MACM presenting to our institution between Jun 2018 and Jan 2019 were prospectively studied and compared to an age and gender matched cohort of dilated non-ischemic CM cases. Results Seventy patients were studied (35 MACM and 35 NMACM). Mean age was similar between groups (49±9 vs. 48±10 years, p=0.465) and 97% of patients were male. Median duration of MA use prior to cardiomyopathy diagnosis was 5 years (range 0-30). Patients were predominantly Hispanic in both groups (48% vs. 62%, p=0.229), but with a greater proportion of Caucasians in the MACM group compared to NMACM (26% vs 6%,p=0.045).MACM was characterized by lower left ventricular ejection fraction (LVEF) and greater left ventricular end diastolic volume (LVEDV) compared to NMACM. RV dilation was present more often in MACM cases (Table). Years of MA use was associated with greater LA volumes (R2= 0.13, p=0.048). Association with larger LVEDV and incidence of RV dilation were borderline significant (R2= 0.11, p=0.054 and p=0.058 respectively). The amount of MA used per week correlated with higher RVSP (R2=0.317, p=0.004). Polysubstance abuse was associated with greater LVEF (p=0.028), lower LVEDV (p=0.037) and lower LV mass (p=0.004). Conclusions MACM is associated with higher degree of LV and RV dilatation as well as LV systolic dysfunction when compared to matched NMACM cases. Years of MA use and amount MA consumed appear to influence severity of disease.

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

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.

Methamphetamine-Associated Cardiomyopathy Versus Other Non-Ischaemic Cardiomyopathies: A Case-Controlled Study

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.

Point-of-Care Ultrasound Identifies Decompensated Heart Failure in a Young Male with Methamphetamine-Associated Cardiomyopathy Presenting in Severe Sepsis to the Emergency Department

We describe a case of a young male who presents to the emergency department with severe sepsis and decompensated heart failure with underlying Methamphetamine-Associated Cardiomyopathy that was previously undiagnosed. This presentation is unique because Methamphetamine-Associated Cardiomyopathy is an uncommonly reported condition that presented in a complex clinical scenario of severe sepsis and decompensated congestive heart failure. We discuss how we used point-of-care ultrasound (POCUS) in this case to identify an unsuspected disease process and how it changed our initial resuscitation strategy and management. Emergency physicians can utilize point-of-care ultrasound (POCUS) to help identify these high-risk patients in the emergency department and guide appropriate resuscitation. Methamphetamine-Associated Cardiomyopathy (MAC) is an infrequently described complication of methamphetamine abuse, most commonly presented as a nonischemic dilated cardiomyopathy. With the rise in methamphetamine abuse in the United States, complications from methamphetamine use are more commonly presenting to the emergency department. Proper education and rehabilitation, with a goal of abstinence from amphetamine use, may allow patients to potentially regain normal cardiac function. Since the majority of patients present late with severe cardiac dysfunction, early detection is essential amongst critically ill patients since recognition may significantly influence ED management.