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Manja V, Nrusimha A, Gao Y, Sheikh A, McGovern M, Heidenreich PA, Sandhu ATS, Asch S. Methamphetamine-associated heart failure: a systematic review of observational studies. Heart 2023; 109:168-177. [PMID: 36456204 DOI: 10.1136/heartjnl-2022-321610] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 09/28/2022] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To conduct a systematic review of observational studies on methamphetamine-associated heart failure (MethHF) . METHODS Six databases were searched for original publications on the topic. Title/abstract and included full-text publications were reviewed in duplicate. Data extraction and critical appraisal for risk of bias were performed in duplicate. RESULTS Twenty-one studies are included in the final analysis. Results could not be combined because of heterogeneity in study design, population, comparator, and outcome assessment. Overall risk of bias is moderate due to the presence of confounders, selection bias and poor matching; overall certainty in the evidence is very low. MethHF is increasing in prevalence, affects diverse racial/ethnic/sociodemographic groups with a male predominance; up to 44% have preserved left-ventricular ejection fraction. MethHF is associated with significant morbidity including worse heart failure symptoms compared with non-methamphetamine related heart failure. Female sex, methamphetamine abstinence and guideline-directed heart failure therapy are associated with improved outcomes. Chamber dimensions on echocardiography and fibrosis on biopsy predict the extent of recovery after abstinence. CONCLUSIONS The increasing prevalence of MethHF with associated morbidity underscores the urgent need for well designed prospective studies of people who use methamphetamine to accurately assess the epidemiology, clinical features, disease trajectory and outcomes of MethHF. Methamphetamine abstinence is an integral part of MethHF treatment; increased availability of effective non-pharmacological interventions for treatment of methamphetamine addiction is an essential first step. Availability of effective pharmacological treatment for methamphetamine addiction will further support MethHF treatment. Using harm reduction principles in an integrated addiction/HF treatment programme will bolster efforts to stem the increasing tide of MethHF.
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Affiliation(s)
- Veena Manja
- VA Center for Innovation to Implementation, Menlo Park, California, USA
- Department of Health Policy, Stanford University, Stanford, California, USA
| | | | - Ya Gao
- McMaster University, Hamilton, Ontario, Canada
| | | | - Mark McGovern
- Stanford University School of Medicine, Stanford, California, USA
| | - Paul A Heidenreich
- VA Center for Innovation to Implementation, Menlo Park, California, USA
- Stanford University School of Medicine, Stanford, California, USA
| | | | - Steven Asch
- VA Center for Innovation to Implementation, Menlo Park, California, USA
- Stanford University School of Medicine, Stanford, California, USA
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2
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Somma V, Osekowski M, Paratz E, Bonomo Y. Methamphetamine-associated cardiomyopathy: an addiction medicine perspective. Intern Med J 2023; 53:21-26. [PMID: 36693638 DOI: 10.1111/imj.15990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 09/22/2022] [Indexed: 01/26/2023]
Abstract
Methamphetamine-associated cardiomyopathy (MaCM) is an increasingly recognised serious complication from methamphetamine (MA) use. It is characterised as the development of otherwise unexplained heart failure in the context of MA use. MaCM predominantly affects a young and vulnerable population with high morbidity and mortality. It is the second leading cause of mortality in patients with MA use disorder (MUD). Our understanding of MaCM pathogenesis is based on observational cohorts and autopsy studies. Currently, the treatment of MaCM is predicated on abstinence. Medical therapies offer some benefit to a minority of patients; however, without abstinence, medical therapies are often ineffective. Abstinence is difficult for most patients to achieve; all clinicians require an understanding of MaCM and how to educate patients on the risks of ongoing use. Where available, referral to addiction medicine specialists to assist with treatment of MUD is recommended. This review aims to: (i) explain the proposed pathologic mechanisms of MaCM; (ii) summarise recent recommendations of the screening and treatment of MaCM; and (iii) highlight the role of addiction medicine in the management of patient with MaCM.
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Affiliation(s)
- Vincenzo Somma
- Department of Addiction Medicine, Department of Cardiology, St Vincent's Hospital Melbourne, Victoria, Melbourne, Australia
| | - Michael Osekowski
- Department of Addiction Medicine, Department of Cardiology, St Vincent's Hospital Melbourne, Victoria, Melbourne, Australia
| | - Elizabeth Paratz
- Department of Addiction Medicine, Department of Cardiology, St Vincent's Hospital Melbourne, Victoria, Melbourne, Australia.,Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
| | - Yvonne Bonomo
- Department of Addiction Medicine, Department of Cardiology, St Vincent's Hospital Melbourne, Victoria, Melbourne, Australia.,Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
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3
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O'Keefe EL, Dhore A, Lavie CJ. Early Onset Cardiovascular Disease from Cocaine, Amphetamines, Alcohol, and Marijuana. Can J Cardiol 2022; 38:1342-1351. [PMID: 35840019 DOI: 10.1016/j.cjca.2022.06.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 06/09/2022] [Accepted: 06/12/2022] [Indexed: 01/16/2023] Open
Abstract
Cardiovascular disease (CVD), a disease typically associated with aging and the definitive leading cause of death worldwide, now threatens the young and middle-aged populations. Recreational abuse of alcohol, marijuana, cocaine and amphetamine-type stimulants has been an escalating public health problem for decades, but now use of these substances has become a significant contributor to early onset CVD. While this remains a global phenomenon, the epicenter of substance abuse is rooted in North America where it has been exacerbated by the COVID-19 pandemic. For the first time in history, the United States (US) crossed 100,000 overdose-related deaths in a calendar year. Sadly, Canada's recreational drug abuse problem closely mirrors that of the US. This is indicative of the larger public health crisis unfolding, as we now know that these substances are cardiotoxic and are contributing to the rising levels of premature chronic CVD, including hypertension, arrhythmias, heart failure, stroke, myocardial infarction, arterial dissection, sudden cardiac death and early mortality.
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Affiliation(s)
| | | | - Carl J Lavie
- John Ochsner Heart and Vascular Institute, Ochsner Clinical School, University of Queensland School of Medicine, New Orleans, LA.
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4
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Dilated cardiomyopathy secondary to methamphetamine intoxication (Shabu). Med Clin (Barc) 2022; 159:e35-e36. [PMID: 35725638 DOI: 10.1016/j.medcli.2022.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/14/2022] [Accepted: 03/16/2022] [Indexed: 11/22/2022]
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5
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White C, Jeanmonod R. Reverse Takotsubo Cardiomyopathy After Accidental Exposure to an Illicit Substance: A Case Report. Cureus 2022; 14:e24282. [PMID: 35602774 PMCID: PMC9119414 DOI: 10.7759/cureus.24282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 11/05/2022] Open
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6
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Hemodynamic Effects of Methamphetamine and General Anesthesia. Anesthesiol Res Pract 2022; 2022:7542311. [PMID: 35222639 PMCID: PMC8872671 DOI: 10.1155/2022/7542311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 12/08/2021] [Accepted: 01/19/2022] [Indexed: 11/18/2022] Open
Abstract
Design A retrospective analysis of all anesthetic records at our institution over a two-year period was performed. Setting. Operating room cases under balanced anesthesia. Patients. All patients with ASA class I or II, who did not have trauma or were initially admitted to ICU, aged 18–65, without preexisting cardiac, renal, or pulmonary disease. Patients were divided into three groups: those acutely positive for methamphetamine within 48 hours of surgery (n = 137), those positive for methamphetamine between 48 hours and 7 days of surgery (n = 69), and randomly selected controls who were negative for methamphetamine within 7 days of surgery (n = 159). Measurements. Intraoperative hemodynamic instability was defined as either a drop of more than 40% in MAP for greater than 5 minutes or requirement for significant amount of vasopressors. Main Results. Among the patients who were acutely positive for methamphetamine within 24 hours, 31.4% met the criteria for hemodynamic instability within the first hour of general anesthesia, compared to 26.1% of the subacutely positive patients and 6.3% of controls (p < 0.0001). This was despite lower doses of anesthetic medications in the acutely and subacutely positive groups. Conclusion Patients who present to the operating room with a positive urine drug screen for amphetamines within 2 days of surgery are at increased risk of hemodynamic instability. Postponing surgery up to 7 days somewhat decreases this risk, but not to the levels of patients who do not use methamphetamines.
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7
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A Comprehensive Approach to Managing Methamphetamine-Associated Cardiomyopathy. Am J Cardiovasc Drugs 2022; 22:385-393. [PMID: 35157254 DOI: 10.1007/s40256-022-00523-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2022] [Indexed: 11/01/2022]
Abstract
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.
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8
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Salimi A, Minouei M, Niknejad M, Mojarad Aylar E. Antioxidant activity of calcitriol reduces direct methamphetamine-induced mitochondrial dysfunction in isolated rat heart mitochondria. TOXIN REV 2021. [DOI: 10.1080/15569543.2021.1978499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Ahmad Salimi
- Department of Pharmacology and Toxicology, School of Pharmacy, Ardabil University of Medical Sciences, Ardabil, Iran
- Traditional Medicine and Hydrotherapy Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Morteza Minouei
- Department of Pharmacology and Toxicology, School of Pharmacy, Ardabil University of Medical Sciences, Ardabil, Iran
- Students Research Committee, Faculty of Pharmacy, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Mohsen Niknejad
- Department of Pharmacology and Toxicology, School of Pharmacy, Ardabil University of Medical Sciences, Ardabil, Iran
- Students Research Committee, Faculty of Pharmacy, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Elham Mojarad Aylar
- Department of Pharmacology and Toxicology, School of Pharmacy, Ardabil University of Medical Sciences, Ardabil, Iran
- Students Research Committee, Faculty of Pharmacy, Ardabil University of Medical Sciences, Ardabil, Iran
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9
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Reddy PKV, Chau E, Patel SV, Yang K, Ng TMH, Elkayam U. Characteristics of Methamphetamine-associated Cardiomyopathy and the Impact of Methamphetamine Use on Cardiac Dysfunction. Am J Cardiol 2021; 154:86-91. [PMID: 34233837 DOI: 10.1016/j.amjcard.2021.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/24/2021] [Accepted: 06/01/2021] [Indexed: 11/25/2022]
Abstract
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.
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10
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Reddy P, Elkayam U. The Hidden Cost of Meth: Appraising the Socioeconomic Burden of Methamphetamine-Associated Cardiomyopathy. Circ Cardiovasc Qual Outcomes 2021; 14:e008214. [PMID: 34256571 DOI: 10.1161/circoutcomes.121.008214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Pavan Reddy
- Division of Cardiovascular Medicine, Icahn School of Medicine, Mount Sinai Morningside, New York (P.R.)
| | - Uri Elkayam
- Department of Medicine, Division of Cardiovascular Medicine, and the Department of Obstetrics and Gynecology Keck School of Medicine, University of Southern California, Los Angeles (U.E.)
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11
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Prokudina ES, Kurbatov BK, Zavadovsky KV, Vrublevsky AV, Naryzhnaya NV, Lishmanov YB, Maslov LN, Oeltgen PR. Takotsubo Syndrome: Clinical Manifestations, Etiology and Pathogenesis. Curr Cardiol Rev 2021; 17:188-203. [PMID: 31995013 PMCID: PMC8226199 DOI: 10.2174/1573403x16666200129114330] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 12/02/2019] [Accepted: 12/12/2019] [Indexed: 12/15/2022] Open
Abstract
The purpose of the review is the analysis of clinical and experimental data on the etiology and pathogenesis of takotsubo syndrome (TS). TS is characterized by contractile dysfunction, which usually affects the apical region of the heart without obstruction of coronary artery, moderate increase in myocardial necrosis markers, prolonged QTc interval (in 50% of patients), sometimes elevation of ST segment (in 19% of patients), increase N-Terminal Pro-B-Type Natriuretic Peptide level, microvascular dysfunction, sometimes spasm of the epicardial coronary arteries (in 10% of patients), myocardial edema, and life-threatening ventricular arrhythmias (in 11% of patients). Stress cardiomyopathy is a rare disease, it is observed in 0.6 - 2.5% of patients with acute coronary syndrome. The occurrence of takotsubo syndrome is 9 times higher in women, who are aged 60-70 years old, than in men. The hospital mortality among patients with TS corresponds to 3.5% - 12%. Physical or emotional stress do not precede disease in all patients with TS. Most of patients with TS have neurological or mental illnesses. The level of catecholamines is increased in patients with TS, therefore, the occurrence of TS is associated with excessive activation of the adrenergic system. The negative inotropic effect of catecholamines is associated with the activation of β2 adrenergic receptors. An important role of the adrenergic system in the pathogenesis of TS is confirmed by studies which were performed using 125I-metaiodobenzylguanidine (125I -MIBG). TS causes edema and inflammation of the myocardium. The inflammatory response in TS is systemic. TS causes impaired coronary microcirculation and reduces coronary reserve. There is a reason to believe that an increase in blood viscosity may play an important role in the pathogenesis of microcirculatory dysfunction in patients with TS. Epicardial coronary artery spasm is not obligatory for the occurrence of TS. Cortisol, endothelin-1 and microRNAs are challengers for the role of TS triggers. A decrease in estrogen levels is a factor contributing to the onset of TS. The central nervous system appears to play an important role in the pathogenesis of TS.
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Affiliation(s)
| | | | | | | | | | | | - Leonid N. Maslov
- Address correspondence to this at the Laboratory of Experimental Cardiology, Cardiology Research Institute, Tomsk National Research Medical Center of the RAS, Tomsk, Russia; E-mail:
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12
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van der Pas RSD, Gresnigt FMJ, Wansink L, Franssen EJF, Riezebos RK. Acute onset heart failure due to reverse type Takotsubo cardiomyopathy caused by a single dose of 4-Fluoroamphetamine in a healthy young individual. Toxicol Rep 2020; 7:1629-1633. [PMID: 33344175 PMCID: PMC7736711 DOI: 10.1016/j.toxrep.2020.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/27/2020] [Accepted: 12/01/2020] [Indexed: 12/30/2022] Open
Abstract
4-Fluoroamphetamine (4-FA) is a popular new psychoactive stimulant that is used for recreational purposes. A single dose of 4-FA can lead to reverse type Takotsubo cardiomyopathy with cardiogenic shock. 4-FA use can cause a very sudden onset of severe symptoms. Due to mild and late onset of effect, 4-FA users have the tendency to take an extra dose. Phosphodiesterase-3-inhibitors are effective for amphetamine type stimulant induced Takotsubo cardiomyopathy.
Introduction 4-fluoroamphetamine (4-FA) is a novel psychoactive stimulant with a global presence on the drug market. Despite the popularity of 4-FA, data on severe adverse effects are scarce. We present a case of laboratory confirmed 4-FA mono intoxication causing acute heart failure due to a reverse type Takotsubo cardiomyopathy. Case A 20-year-old male with no previous medical history and no reported previous drug use, presented to the emergency department (ED) with complaints of headache, nausea and vomiting, approximately 4.5 h after the ingestion of a single 4-FA pill. After 30 min his condition deteriorated with severe hypertension, tachycardia and respiratory failure. Echocardiography showed a reverse type Takotsubo cardiomyopathy. The patient was successfully treated with mechanical ventilation, a phosphodiesterase-3-inhibitor (PDE3-inhibitor) and diuretics. Three months after hospital admission, the patient was free of complaints and his left ventricular function fully recovered. Conclusion Recreational use of 4-FA may result in acute onset life-threatening cardiorespiratory toxicity, preceded by severe hypertension, even in drug-naïve patients without any medical history. Emergency physicians and cardiologists should be cautious not to underestimate life-threatening 4-FA complications.
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Affiliation(s)
- R S D van der Pas
- Emergency medicine at OLVG hospital, Amsterdam, the Netherlands.,Emergency registrars at Sint Antonius hospital, Nieuwegein, the Netherlands
| | - F M J Gresnigt
- Emergency Physician at OLVG Hospital, Amsterdam, the Netherlands
| | - L Wansink
- Emergency medicine at OLVG hospital, Amsterdam, the Netherlands.,Emergency Physician at Dijklander ziekenhuis, Hoorn, the Netherlands
| | | | - R K Riezebos
- Cardiologist at OLVG Hospital, Amsterdam, the Netherlands
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13
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Sancho Santos ME, Grabicová K, Steinbach C, Schmidt-Posthaus H, Šálková E, Kolářová J, Vojs Staňová A, Grabic R, Randák T. Environmental concentration of methamphetamine induces pathological changes in brown trout (Salmo trutta fario). CHEMOSPHERE 2020; 254:126882. [PMID: 32957289 DOI: 10.1016/j.chemosphere.2020.126882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/03/2020] [Accepted: 04/23/2020] [Indexed: 06/11/2023]
Abstract
Methamphetamine, mainly consumed as an illicit drug, is a potent addictive psychostimulant that has been detected in surface water at concentrations ranging from nanograms to micrograms per litre, especially in Middle and East Europe. The aim of this study was to expose brown trout (Salmo trutta fario) to environmental (1 μg L-1) and higher (50 μg L-1) concentrations of methamphetamine for 35 days with a four-day depuration phase to assess the possible negative effects on fish health. Degenerative liver and heart alterations, similar to those described in mammals, were observed at both concentrations, although at different intensities. Apoptotic changes in hepatocytes, revealed by activated caspase-3, were found in exposed fish. The parent compound and a metabolite (amphetamine) were detected in fish tissues in both concentration groups, in the order of kidney > liver > brain > muscle > plasma. Bioconcentration factors ranged from 0.13 to 80. A therapeutic plasma concentration was reached for both compounds in the high-concentration treatment. This study indicates that chronic environmental concentrations of methamphetamine can lead to health issues in aquatic organisms.
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Affiliation(s)
- Maria Eugenia Sancho Santos
- University of South Bohemia in České Budějovice, Faculty of Fisheries and Protection of Waters, South Bohemian Research Center of Aquaculture and Biodiversity of Hydrocenoses, Zátiší 728/II, 389 25, Vodňany, Czech Republic.
| | - Kateřina Grabicová
- University of South Bohemia in České Budějovice, Faculty of Fisheries and Protection of Waters, South Bohemian Research Center of Aquaculture and Biodiversity of Hydrocenoses, Zátiší 728/II, 389 25, Vodňany, Czech Republic
| | - Christoph Steinbach
- University of South Bohemia in České Budějovice, Faculty of Fisheries and Protection of Waters, South Bohemian Research Center of Aquaculture and Biodiversity of Hydrocenoses, Zátiší 728/II, 389 25, Vodňany, Czech Republic
| | - Heike Schmidt-Posthaus
- University of Bern, Centre for Fish and Wildlife Health, Department of Infectious Diseases and Pathobiology, Laenggassstrasse 122, 3001, Bern, Switzerland
| | - Eva Šálková
- University of South Bohemia in České Budějovice, Faculty of Fisheries and Protection of Waters, South Bohemian Research Center of Aquaculture and Biodiversity of Hydrocenoses, Zátiší 728/II, 389 25, Vodňany, Czech Republic
| | - Jitka Kolářová
- University of South Bohemia in České Budějovice, Faculty of Fisheries and Protection of Waters, South Bohemian Research Center of Aquaculture and Biodiversity of Hydrocenoses, Zátiší 728/II, 389 25, Vodňany, Czech Republic
| | - Andrea Vojs Staňová
- University of South Bohemia in České Budějovice, Faculty of Fisheries and Protection of Waters, South Bohemian Research Center of Aquaculture and Biodiversity of Hydrocenoses, Zátiší 728/II, 389 25, Vodňany, Czech Republic; Comenius University in Bratislava, Faculty of Natural Sciences, Department of Analytical Chemistry, Ilkovicova 6, SK-842 15, Bratislava, Slovak Republic
| | - Roman Grabic
- University of South Bohemia in České Budějovice, Faculty of Fisheries and Protection of Waters, South Bohemian Research Center of Aquaculture and Biodiversity of Hydrocenoses, Zátiší 728/II, 389 25, Vodňany, Czech Republic
| | - Tomáš Randák
- University of South Bohemia in České Budějovice, Faculty of Fisheries and Protection of Waters, South Bohemian Research Center of Aquaculture and Biodiversity of Hydrocenoses, Zátiší 728/II, 389 25, Vodňany, Czech Republic
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14
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Heart Failure in Vulnerable Populations: The Emerging Evidence of Methamphetamine-Associated Cardiomyopathy. CURRENT CARDIOVASCULAR RISK REPORTS 2020. [DOI: 10.1007/s12170-020-00653-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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15
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Freeling JL, McFadden LM. The emergence of cardiac changes following the self-administration of methamphetamine. Drug Alcohol Depend 2020; 212:108029. [PMID: 32408136 PMCID: PMC7293916 DOI: 10.1016/j.drugalcdep.2020.108029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 03/16/2020] [Accepted: 04/13/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND Clinical observations suggest an association between methamphetamine (METH) use and cardiovascular disease, but preclinical studies are lacking. The purpose of the current study was to explore changes in left ventricular function as a potential precursor to cardiovascular disease in a rodent model of METH use. METHODS Male rats were allowed to self-administer either METH or saline for 9 d. On the day following the 4th and 9th self-administration sessions, an echocardiogram was performed to assess left-ventricular parameters under basal conditions and following a low-dose of METH (1 mg/kg). RESULTS A low challenge dose of METH resulted in subtle but statistically significant changes in cardiac function during the echocardiogram in both the METH and saline self-administering groups. Further, differences in left-ventricular parameters such as stroke volume and heart rate were observed between METH and saline groups following the 9th self-administration session. Finally, supervised machine learning correctly predicted the self-administration group assignment (saline or METH) using cardiac parameters following the 9th self-administration session. CONCLUSIONS The findings of the current study suggest the heart, specifically the left ventricle, is sensitive to METH. Overall, these findings and emerging clinical observations highlight the need for research to investigate the effects of METH use on the heart.
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Affiliation(s)
- Jessica L. Freeling
- Physiology Core, Division of Basic Biomedical Sciences, University of South Dakota, Vermillion SD 57069
| | - Lisa M. McFadden
- Center for Brain and Behavioral Research, Division of Basic Biomedical Sciences, University of South Dakota, Vermillion SD 57069
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16
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Reddy PKV, Ng TMH, Oh EE, Moady G, Elkayam U. Clinical Characteristics and Management of Methamphetamine-Associated Cardiomyopathy: State-of-the-Art Review. J Am Heart Assoc 2020; 9:e016704. [PMID: 32468897 PMCID: PMC7428977 DOI: 10.1161/jaha.120.016704] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Methamphetamine‐associated cardiomyopathy (MACM) is an increasingly recognized disease entity in the context of a rapidly spreading methamphetamine epidemic. MACM may afflict individuals with a wide range of ages and socioeconomic backgrounds. Presentations can vary greatly and may involve several complications unique to the disease. Given the public health significance of this disease, there is a relative dearth of consensus material to guide clinicians in understanding, diagnosing, and managing MACM. This review therefore aims to: (1) describe pathologic mechanisms of methamphetamine as they pertain to the development, progression, and prognosis of MACM, and the potential to recover cardiac function; (2) summarize existing data from epidemiologic studies and case series in an effort to improve recognition and diagnosis of the disease; (3) guide short‐ and long‐term management of MACM with special attention to expected or potential sequelae of the disease; and (4) highlight pivotal unanswered questions in need of urgent investigation from a public health perspective.
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Affiliation(s)
- Pavan K V Reddy
- Division of Cardiovascular Medicine Keck School of Medicine University of Southern California Los Angeles CA
| | - Tien M H Ng
- School of Pharmacy University of Southern California Los Angeles CA
| | - Esther E Oh
- School of Pharmacy University of Southern California Los Angeles CA
| | - Gassan Moady
- Division of Cardiovascular Medicine Keck School of Medicine University of Southern California Los Angeles CA
| | - Uri Elkayam
- Division of Cardiovascular Medicine Keck School of Medicine University of Southern California Los Angeles CA
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Dalal S, Arustamyan M, Marmolejos G, Ramakrishna K. Delayed cardiomyopathy and cardiogenic shock due to intravenous methamphetamine use requiring hemodynamic support with veno-arterial extracorporeal membrane oxygenation. J Am Coll Emerg Physicians Open 2020; 1:117-119. [PMID: 33000022 PMCID: PMC7493537 DOI: 10.1002/emp2.12027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 01/22/2020] [Accepted: 01/22/2020] [Indexed: 11/14/2022] Open
Abstract
Cardiovascular disease is the leading cause of mortality in chronic methamphetamine users. We present the case of a 29-year-old man, a prior heroin user, who presented following first-time use of intravenous methamphetamine, with delayed development of cardiomyopathy and severe cardiogenic shock, treated with veno-arterial extracorporeal membrane oxygenation (VA ECMO), and subsequent recovery. His initial chief complaint was shortness of breath, a common presentation to the emergency department. However, this case presentation is unique in three aspects: (1) a delayed presentation, (2) methamphetamine was administered intravenously as opposed to the common methods of being snorted or smoked, (3) and the effects were seen after first-time usage as compared to in a chronic user. This unique presentation can bring awareness to an uncommon etiology of shortness of breath due to intravenous methamphetamine usage.
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Affiliation(s)
- Sonia Dalal
- Department of MedicineUniversity of Maryland Medical CenterBaltimoreMaryland
| | | | - Ginny Marmolejos
- Department of Thoracic Medicine and SurgeryLewis Katz School of MedicinePhiladelphiaPennsylvania
| | - Kartik Ramakrishna
- Department of Pulmonary Critical Care and Sleep MedicineSUNY Upstate Medical UniversitySyracuseNew York
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18
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Thomas IC, Nishimura M, Ma J, Dickson SD, Alshawabkeh L, Adler E, Maisel A, Criqui MH, Greenberg B. Clinical Characteristics and Outcomes of Patients With Heart Failure and Methamphetamine Abuse. J Card Fail 2020; 26:202-209. [DOI: 10.1016/j.cardfail.2019.10.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 08/26/2019] [Accepted: 10/07/2019] [Indexed: 11/15/2022]
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19
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Schwarzbach V, Lenk K, Laufs U. Methamphetamine-related cardiovascular diseases. ESC Heart Fail 2020; 7:407-414. [PMID: 31950731 PMCID: PMC7160483 DOI: 10.1002/ehf2.12572] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/02/2019] [Accepted: 11/11/2019] [Indexed: 12/23/2022] Open
Abstract
Aims Abuse of crystal methamphetamine (MA) poses a growing problem for health services worldwide. This review summarizes the current literature on the effects of MA on the cardiovascular system. Methods and results This article is a presentation of a case report and review of the current literature. In Europe, especially the eastern countries and the eastern states of Germany are affected. MA increases the concentration of catecholamines in the synaptic gap leading to euphoria, alertness, and hunger suppression as well as psychiatric and gastrointestinal complications. MA consumption is associated with hypertension, acute and chronic myocardial toxicity, stroke, coronary artery disease, and sudden cardiac death. Although many aspects of the underlying pathophysiology remain unknown, catecholamine‐mediated pathologies appear to play an important role. The duration of MA consumption is the most important determinant for the prognosis. Conclusions Awareness is needed as cardiac complications are important causes of morbidity and mortality in patients with MA consumption. Drug abstinence is the mainstay of therapy, cardiac and other complications should be treated according to the respective guidelines. Incompliance to therapy and frequent relapses are the main challenges for successful treatment. Further research is required to improve the understanding of this rapidly increasing cardiomyopathy.
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Affiliation(s)
- Valentin Schwarzbach
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Karsten Lenk
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany
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20
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Berlot B, Williams MGL, Bucciarelli-Ducci C. The colours of amphetamine-induced cardiomyopathy. J Cardiovasc Med (Hagerstown) 2020; 21:396-397. [PMID: 31895130 DOI: 10.2459/jcm.0000000000000922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Bostjan Berlot
- Bristol Heart Institute, Bristol National Institute of Health Research (NIHR) Biomedical Research Centre, University Hospitals Bristol NHS Trust and University of Bristol.,Bristol Medical School, University of Bristol, Bristol, UK.,Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Matthew G L Williams
- Bristol Heart Institute, Bristol National Institute of Health Research (NIHR) Biomedical Research Centre, University Hospitals Bristol NHS Trust and University of Bristol.,Bristol Medical School, University of Bristol, Bristol, UK
| | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, Bristol National Institute of Health Research (NIHR) Biomedical Research Centre, University Hospitals Bristol NHS Trust and University of Bristol.,Bristol Medical School, University of Bristol, Bristol, UK
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21
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Zhao SX, Seng S, Deluna A, Yu EC, Crawford MH. Comparison of Clinical Characteristics and Outcomes of Patients With Reversible Versus Persistent Methamphetamine-Associated Cardiomyopathy. Am J Cardiol 2020; 125:127-134. [PMID: 31699360 DOI: 10.1016/j.amjcard.2019.09.030] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 09/16/2019] [Accepted: 09/17/2019] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
- Susan X Zhao
- Division of Cardiology, Santa Clara Valley Medical Center, San Jose, CA.
| | - Sakara Seng
- Department of Medicine, Santa Clara Valley Medical Center, San Jose, CA
| | - Andres Deluna
- Division of Cardiology, Santa Clara Valley Medical Center, San Jose, CA
| | - Elizabeth C Yu
- Division of Cardiology, Santa Clara Valley Medical Center, San Jose, CA
| | - Michael H Crawford
- Division of Cardiology, University of California, San Francisco, San Francisco, CA
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22
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Reversible methamphetamine-induced cardiomyopathy mimicking arrhythmogenic right ventricular cardiomyopathy with ventricular tachycardia. HeartRhythm Case Rep 2019; 6:139-143. [PMID: 32181132 PMCID: PMC7064801 DOI: 10.1016/j.hrcr.2019.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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23
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Clinical Characteristics and Outcome of Methamphetamine-Associated Pulmonary Arterial Hypertension and Dilated Cardiomyopathy. JACC-HEART FAILURE 2019; 6:209-218. [PMID: 29496022 DOI: 10.1016/j.jchf.2017.10.006] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 10/05/2017] [Accepted: 10/07/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVES This study sought to characterize patients with methamphetamine-associated pulmonary arterial hypertension (MA-PAH) and cardiomyopathy (MA-CMP), to compare with MA controls (MA-CTL), users with structurally normal hearts, with the aim of identifying risk factors for these conditions. BACKGROUND MA-PAH and MA-CMP are 2 poorly understood cardiac complications in MA users. METHODS We retrospectively studied the clinical characteristics and outcomes of 50 MA-PAH, 296 MA-CMP, and 356 MA-CTL patients, whom we evaluated between 2010 and 2017. RESULTS After a median follow-up of 20.0 months (interquartile range [IQR]: 7.6 to 42.6 months), all-cause mortality was 18.0% for MA-PAH, 15.2% for MA-CMP, and 4.5% for MA-CTL group (p < 0.001). More women (58%) were in the MA-PAH group than in the MA-CMP (14%; p < 0.001) and MA-CTL (42%; p = 0.028) groups, whereas the MA-CMP group was predominantly male (86% vs. 58% in the MA-CTL group; p < 0.001). More MA-CMP patients had hypertension (p < 0.001) or alcoholism (p < 0.001) than MA-CTL patients. Logistic regression analyses identified male sex, alcoholism, and hypertension as independent factors associated with MA-CMP with the following respective adjusted odds ratios (OR) of 3.791 (95% confidence interval [CI]: 2.508 to 5.730), OR of 2.959 (95% CI: 2.084 to 4.203), and OR of 2.111 (95% CI: 1.486 to 2.999), whereas female sex was the only factor associated with MA-PAH. CONCLUSIONS Both MA-PAH and MA-CMP patients carried significant disease burden and mortality risk. Male sex, hypertension, and alcoholism were strongly associated with MA-CMP, whereas female sex and other unknown factors may influence development of MA-PAH. This study adds to the understanding of MA-associated cardiac complications and highlights directions for future investigation.
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24
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Santuré Sinfreu A, Buil Arasanz ME, Esparza Siegel L. Complicaciones cardiovasculares de las metanfetaminas: estudio de 6 casos. Med Clin (Barc) 2019; 153:e41-e43. [DOI: 10.1016/j.medcli.2019.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 01/03/2019] [Accepted: 01/10/2019] [Indexed: 11/15/2022]
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25
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Richards JR, Harms BN, Kelly A, Turnipseed SD. Methamphetamine use and heart failure: Prevalence, risk factors, and predictors. Am J Emerg Med 2018; 36:1423-1428. [DOI: 10.1016/j.ajem.2018.01.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 12/12/2017] [Accepted: 01/01/2018] [Indexed: 01/30/2023] Open
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26
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Kwon NJ, Han E. A commentary on the effects of methamphetamine and the status of methamphetamine abuse among youths in South Korea, Japan, and China. Forensic Sci Int 2018; 286:81-85. [DOI: 10.1016/j.forsciint.2018.02.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 10/31/2017] [Accepted: 02/18/2018] [Indexed: 12/11/2022]
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27
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Darke S, Kaye S, Duflou J. Rates, characteristics and circumstances of methamphetamine-related death in Australia: a national 7-year study. Addiction 2017; 112:2191-2201. [PMID: 28603836 DOI: 10.1111/add.13897] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Revised: 05/10/2017] [Accepted: 06/06/2017] [Indexed: 11/28/2022]
Abstract
AIMS To (1) assess trends in the number and mortality rates of methamphetamine-related death in Australia, 2009-15; (2) assess the characteristics and the cause, manner and circumstances of death; and (3) assess the blood methamphetamine concentrations and the presence of other drugs in methamphetamine-related death. DESIGN Analysis of cases of methamphetamine-related death retrieved from the National Coronial Information System (NCIS). SETTING Australia. CASES All cases in which methamphetamine was coded in the NCIS database as a mechanism contributing to death (n = 1649). MEASUREMENTS Information was collected on cause and manner of death, demographics, location, circumstances of death and toxicology. FINDINGS The mean age of cases was 36.9 years, and 78.4% were male. The crude mortality rate was 1.03 per 100 000. The rate increased significantly over time (P < 0.001), and at 2015 the mortality rate was 1.8 [confidence interval (CI) = 1.2-2.4] times that of 2009. Deaths were due to accidental drug toxicity (43.2%), natural disease (22.3%), suicide (18.2%), other accident (14.9%) and homicide (1.5%). In 40.8% of cases, death occurred outside the major capital cities. The median blood methamphetamine concentration was 0.17 mg/l, and cases in which only methamphetamine was detected had higher concentrations than other cases (0.30 versus 0.15 mg/l, P < 0.001). The median blood methamphetamine concentration varied within a narrow range (0.15-0.20 mg/l) across manner of death. In the majority (82.8%) of cases, substances other than methamphetamine were detected, most frequently opioids (43.1%) and hypnosedatives (38.0%). CONCLUSIONS Methamphetamine death rates doubled in Australia from 2009 to 2015. While toxicity was the most frequent cause, natural disease, suicide and accident comprised more than half of deaths.
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Affiliation(s)
- Shane Darke
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia
| | - Sharlene Kaye
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia.,Justice Health and Forensic Mental Health Network, NSW Health, NSW, Australia
| | - Johan Duflou
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, Australia.,Sydney Medical School, University of Sydney, NSW, Australia
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28
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Lappin JM, Darke S, Farrell M. Stroke and methamphetamine use in young adults: a review. J Neurol Neurosurg Psychiatry 2017; 88:1079-1091. [PMID: 28835475 DOI: 10.1136/jnnp-2017-316071] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 05/04/2017] [Accepted: 06/13/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Methamphetamine use and stroke are significant public health problems. Strokes among people aged below 45 years are much less common than in older age groups but have significant mortality and morbidity. Methamphetamine is a putative cause of strokes among younger people. METHODS A review of methamphetamine-related strokes was conducted. Bibliographic databases were searched until February 2017 for articles related to methamphetamine and stroke. Both haemorrhagic and ischaemic strokes were considered. RESULTS Of 370 articles screened, 77 were selected for inclusion. There were 81 haemorrhagic and 17 ischaemic strokes reported in case reports and series. Both types were approximately twice as common in males. Route of administration associated with haemorrhagic stroke was typically oral or injecting, but for ischaemic stroke inhalation was most common. Haemorrhagic stroke was associated with vascular abnormalities in a third of cases. One quarter of individuals completely recovered, and a third died following haemorrhagic stroke. One-fifth completely recovered, and one-fifth died following ischaemic stroke. CONCLUSIONS There is a preponderance of haemorrhagic strokes associated with methamphetamine use in young people, and methamphetamine-related stroke is associated with poor clinical outcomes. Mechanisms of methamphetamine-associated stroke include hypertension, vasculitis, direct vascular toxicity and vasospasm. In a period of rising worldwide methamphetamine use, the incidence of methamphetamine-related stroke will increase, with a consequent increase in the burden of disease contributed by such events.
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Affiliation(s)
- Julia M Lappin
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, New South Wales, Australia
- School of Psychiatry, University of New South Wales, Sydney, New South Wales, Australia
| | - Shane Darke
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, New South Wales, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre (NDARC), University of New South Wales, Sydney, New South Wales, Australia
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29
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Pujol-López M, Ortega-Paz L, Roqué M, Bosch X. Severe Cardiac Complications of Shabu Use: An Emerging Drug in Europe. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2017; 70:1014-1016. [PMID: 28139393 DOI: 10.1016/j.rec.2016.12.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Accepted: 11/23/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Margarida Pujol-López
- Servicio de Cardiología, Institut Clínic Cardiovascular, Hospital Clínic, Universidad de Barcelona, Barcelona, Spain
| | - Luis Ortega-Paz
- Servicio de Cardiología, Institut Clínic Cardiovascular, Hospital Clínic, Universidad de Barcelona, Barcelona, Spain
| | - Mercè Roqué
- Servicio de Cardiología, Institut Clínic Cardiovascular, Hospital Clínic, Universidad de Barcelona, Barcelona, Spain
| | - Xavier Bosch
- Servicio de Cardiología, Institut Clínic Cardiovascular, Hospital Clínic, Universidad de Barcelona, Barcelona, Spain.
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30
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Pujol-López M, Ortega-Paz L, Roqué M, Bosch X. Complicaciones cardiacas graves por shabu: una droga emergente en Europa. Rev Esp Cardiol (Engl Ed) 2017. [DOI: 10.1016/j.recesp.2016.11.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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31
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Exposure to Amphetamines Leads to Development of Amphetamine Type Stimulants Associated Cardiomyopathy (ATSAC). Cardiovasc Toxicol 2017; 17:13-24. [PMID: 27663745 DOI: 10.1007/s12012-016-9385-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
With rapidly rising prevalence of exposure to Amphetamine Type Stimulants (ATS), novel insights into cardiotoxic effects of this substance are being presented in the literature and remarkably ATS Associated Cardiomyopathy (ATSAC) is emerging as a novel cardiovascular condition with its distinctive pathogenesis, risk factors, clinical features and prognosis. A comprehensive systematic review was performed to explore and analyze the current evidence on the association between ATS exposure and development of cardiomyopathy, biological mechanisms involved in pathogenesis of ATSAC, risk factors, clinical features and course of patients with ATSAC. Several animal studies, case reports, case series and case-control studies support the association between ATS exposure and ATSAC. Oxidative stress, accelerated apoptosis, increased p53 activity, cardiomyocyte necrosis, perfusion defects, fatty acid toxicity, altered gene expression, abnormal cardiac protein synthesis and function in addition to defects in intracellular calcium hemostasis present themselves as likely mechanisms of cardiotoxicity in ATSAC. Majority of patients with ATSAC were found to be male, young and presented late with severe dilated cardiomyopathy. Female ATS users predominantly develop Takotsubo type of ATSAC and in particular its atypical basal variant. Overall, cessation of ATS exposure seems to be associated with some degree of reversibility and recovery in ATSAC sufferers.
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32
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Darke S, Duflou J, Kaye S. Prevalence and nature of cardiovascular disease in methamphetamine-related death: A national study. Drug Alcohol Depend 2017; 179:174-179. [PMID: 28787694 DOI: 10.1016/j.drugalcdep.2017.07.001] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 07/06/2017] [Accepted: 07/06/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND Methamphetamine dependence is a major public health problem. This study examined the nature, and extent, of cardiovascular disease amongst cases of methamphetamine-related death in Australia, 2009-2015. METHODS Analysis of 894 cases of methamphetamine-related death with full autopsy reports retrieved from the National Coronial Information System. RESULTS The mean age was 37.9yrs (range 15-69yrs) and 78.5% were male. A quarter (26.3%) of cases had enlarged hearts and left ventricular hypertrophy was diagnosed in 18.9%. Severe coronary artery disease was present in 19.0%, the left coronary artery being the vessel most frequently stenosed (16.6%). Replacement fibrosis (evidence of earlier ischaemic events) in the heart muscle was observed in 19.8% of cases, and cardiomyopathy was diagnosed in 5.5%. Histological evidence of hypertension was observed in 32.7% of cases. With the exception of cardiomyopathy, equally common amongst both sexes, cardiovascular disease was more common amongst males, and those aged >35yrs. Clinically significant levels of cardiovascular disease were also observed amongst cases where the cause of death was not attributed to cardiovascular disease: cardiomegaly (19.3%), left ventricular hypertrophy (14.6%), severe coronary artery disease (9.4%), replacement fibrosis (14.4%), cardiomyopathy (3.3%). CONCLUSIONS Cardiovascular disease was highly prevalent, despite the relatively young age of cases. With methamphetamine use increasing rapidly in major regions, cardiovascular disease and cardiovascular-related death will likely increase amongst methamphetamine users.
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Affiliation(s)
- Shane Darke
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, 2052, Australia.
| | - Johan Duflou
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, 2052, Australia; Sydney Medical School, University of Sydney, NSW, Australia
| | - Sharlene Kaye
- National Drug and Alcohol Research Centre, University of New South Wales, NSW, 2052, Australia; Justice Health and Forensic Mental Health Network, NSW Justice Health, NSW Australia
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Abstract
Complications related to methamphetamine use and abuse are common presentations seen in the emergency department. Standard management focuses on addressing the central nervous system and cardiovascular effects with the use of sedation and hemodynamic support. We describe a case report of a patient with methamphetamine toxicity and subsequent severe cardiomyopathy refractory to conventional management that responded to cardiovascular support with extracorporeal membrane oxygenation therapy (ECMO). A 22-year-old female was admitted in severe cardiogenic shock following intravenous administration of methamphetamine and oral fentanyl use. Despite aggressive treatment with benzodiazepines, intravenous fluids, vasopressors, vasodilators, antibiotics and inotropes, the patient's clinical status deteriorated, and she suffered a cardiac arrest. The patient was successfully resuscitated, and following the return of spontaneous circulation, ECMO was initiated. After 82 hours the patient was successfully weaned from ECMO with the recovery of her left ventricular function and no neurologic sequelae. The patient developed leg ischemia requiring embolectomy and open repair as a complication of ECMO cannulation. In our case, ECMO was used successfully in treating severe cardiac dysfunction from acute methamphetamine-induced cardiomyopathy and was used as a bridge to recovery. The complications seen in this patient emphasize the potential risks associated with this intervention and highlight the need for careful patient selection.
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Clinical Characteristics, Histopathological Features, and Clinical Outcome of Methamphetamine-Associated Cardiomyopathy. JACC-HEART FAILURE 2017; 5:435-445. [DOI: 10.1016/j.jchf.2017.02.017] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 02/08/2017] [Accepted: 02/10/2017] [Indexed: 12/23/2022]
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35
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Madias JE. Methamphetamine-triggered Takotsubo syndrome and methamphetamine-associated cardiomyopathy: a continuum? Intern Med J 2016; 46:752-3. [PMID: 27257158 DOI: 10.1111/imj.13102] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 03/22/2016] [Accepted: 03/29/2016] [Indexed: 11/29/2022]
Affiliation(s)
- J E Madias
- Icahn School of Medicine at Mount Sinai, New York, New York, USA.,Division of Cardiology, Elmhurst Hospital Center, Elmhurst, New York, USA
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36
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Voskoboinik A. Author reply. Intern Med J 2016; 46:753. [DOI: 10.1111/imj.13101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 04/06/2016] [Indexed: 11/28/2022]
Affiliation(s)
- A. Voskoboinik
- Department of Cardiology; Alfred Hospital; Melbourne Victoria Australia
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