Author + information
- Margarida Pujol-López, MD∗ (, )
- Luis Ortega-Paz, MD,
- Eduardo J. Flores-Umanzor, MD,
- Rosario J. Perea, MD, PhD and
- Xavier Bosch, MD, PhD
- ↵∗Cardiology Department, Institut Clínic Cardiovascular, Hospital Clínic de Barcelona, Universitat de Barcelona, Villarroel 170, 08036 Barcelona Spain
We read with interest the article published by Schürer et al. (1) in which they evaluated the relationship between the prognosis of methamphetamine-associated cardiomyopathy (MACM) and methamphetamine (MA) consumption. They suggest that the cessation of MA abuse together with medical therapy partially recovered left ventricular ejection fraction (LVEF). Moreover, the extension of fibrosis assessed by endomyocardial biopsy (EMB) was an independent predictor of LVEF recovery.
We conducted a prospective study of MA consumers who were admitted to our hospital due to heart failure from January 2015 to July 2017. All patients (N = 6) had severe ventricular dysfunction (mean LVEF: 16.2 ± 5.5%). Three patients with chronic MA use presented late gadolinium enhancement (LGE) in cardiac magnetic resonance (CMR); the observed patterns were multiple foci and foci in the interventricular union.
One year follow-up examinations were performed in 4 cases: 2 patients recovered a normal LVEF. One patient with chronic abuse showed no LGE, and nonadherence to treatment resulted in no improvement in LVEF. One patient with multiple foci of LGE persisted with severe ventricular dysfunction at 1 year despite medical treatment. Two patients who stopped using MA and without multiple foci of LGE showed normal LVEF recovery.
CMR with LGE may be a good alternative to EMB to study fibrosis and myocardial disease extension. Multiple foci of LGE could be associated with a lack of recovery of the LVEF. In an isolated case report of MACM, absence of fibrosis on CMR predicted ventricular function recovery (2).
The use of CMR could avoid the complications associated with EMB (3,4) and allow a comprehensive morphological study of both ventricles. Furthermore, EMB could not be representative of the entire myocardial pathology because it can be patched. However, the EMB could give additional information such as the inflammation process.
MA is an emerging drug in Europe with increasing consumption reports, especially in Southeast Asian communities (5). In this context, CMR may be a good tool to evaluate the cardiac morphology and predict LVEF recovery in MACM. Further studies are needed to assess the association between LGE, fibrosis, and MACM prognosis.
Please note: The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- 2017 American College of Cardiology Foundation
- Schürer S.,
- Klingel K.,
- Sandri M.,
- et al.
- Isogai T.,
- Yasunaga H.,
- Matsui H.,
- et al.
- Pujol-López M.,
- Ortega-Paz L.,
- Roqué M.,
- Bosch X.