Echocardiographic characteristics of new-onset methamphetamine-associated heart failure: a retrospective cohort study.

BACKGROUND

Methamphetamine-associated heart failure (MAHF) is a growing cause of healthcare burden, yet the echocardiographic phenotype at the time of initial diagnosis is poorly characterized. We tested the hypothesis that new-onset MAHF exhibits a distinct echocardiographic phenotype that could aid in early disease identification.

METHODS

We conducted a retrospective cohort study comparing echocardiographic parameters in patients with new-onset MAHF versus controls with non-ischemic cardiomyopathy unrelated to methamphetamine use. Patients with MAHF (n = 75) were identified by positive urine drug screen, ICD-10 codes for incident heart failure, and confirmed active methamphetamine use at index hospitalization. Controls were matched 1:1 by age, sex, and race. Pre-specified echocardiographic endpoints included left and right ventricular size and function, left ventricular thrombi, valvular dysfunction, and pulmonary artery systolic pressure.

RESULTS

The two groups showed no significant differences in echocardiographic parameters. Left ventricular ejection fraction (28%, 20-36% vs. 25%, 19-35%), left ventricular indexed end-diastolic volume (103 ml/m2, 79-130 ml/m2 vs. 94 ml/m2, 73-118 ml/m2), left atrial size, right ventricular size and function, diastolic parameters, pulmonary artery pressures, and prevalence of ventricular thrombi were all similar between groups.

CONCLUSIONS

At the time of initial heart failure diagnosis, MAHF is indistinguishable by traditional echocardiographic parameters from other non-ischemic cardiomyopathies. The findings of this study differ from prior research into the echocardiographic phenotype of MAHF by focusing on the time of initial heart failure diagnosis, presumably when less adverse remodeling has occurred. These negative findings underscore that MAHF is a diagnosis of exclusion and a full work-up to assess for alternative etiologies of cardiomyopathy is paramount.