Cardiology Department, ASL Torino, Italy.
J Cardiovasc Med (Hagerstown). 2011 Jan;12(1):51-4. doi: 10.2459/JCM.0b013e32834033f2.
Illicit drugs such as cocaine, and methadone can induce acquired long QT syndrome.
The aim of this study was to evaluate the prevalence of cardiovascular disease and to assess the risk of torsades de pointes in substance abuse patients either with methadone or buprenorphine maintenance therapy, or without any specific therapy for opiate addiction.
From November 2008 to December 2009, 190 patients (153 men, mean age 38.2 years, 22-56 years) with a substance use disorder according to DSM IV TR criteria were included in the study. All patients underwent blood tests, serial electrocardiogram (ECG) and, when necessary, additional testing, including echocardiogram, exercise test and Holter monitoring. Age and sex-matched healthy controls were also evaluated and compared with the cases.
One hundred and twenty-five patients (65.7%) had associated diseases. The prevalence of coronary artery disease and hypertension was, respectively, 2.1 and 5.2% in the addicted population. The percentage of abnormal ECGs was 34.2% in the addicted population and 4.7% in the nonaddicted population (P < 0.001). Twenty-five addicted patients had a QT interval prolongation (10 patients ≥ 480 ms). There were no sudden deaths or major cardiac events during the observation period.
Our results indicate that the QT interval prolongation is not a negative prognostic marker in the addicted population, even with associated diseases. ECG should be performed when other drugs potentially prolonging QT interval are associated. Substance abuse patients should be followed by multidisciplinary teams, and blood tests and ECGs should be performed regularly.
可卡因和美沙酮等非法药物可导致获得性长 QT 综合征。
本研究旨在评估心血管疾病的患病率，并评估接受美沙酮或丁丙诺啡维持治疗或未接受阿片类药物成瘾特殊治疗的滥用药物患者发生尖端扭转型室性心动过速的风险。
2008 年 11 月至 2009 年 12 月，根据 DSM-IV-TR 标准，纳入 190 名物质使用障碍患者（153 名男性，平均年龄 38.2 岁，22-56 岁）。所有患者均接受了血液检查、连续心电图（ECG）检查，必要时还进行了其他检查，包括超声心动图、运动试验和动态心电图监测。还评估了年龄和性别匹配的健康对照组，并与病例组进行了比较。
125 名患者（65.7%）合并有相关疾病。在成瘾人群中，冠心病和高血压的患病率分别为 2.1%和 5.2%。在成瘾人群中，心电图异常的百分比为 34.2%，而非成瘾人群为 4.7%（P < 0.001）。25 名成瘾患者存在 QT 间期延长（10 名患者≥480 ms）。在观察期间，没有发生猝死或重大心脏事件。
我们的结果表明，即使存在合并症，QT 间期延长在成瘾人群中也不是一个负性预后标志物。当存在其他潜在延长 QT 间期的药物时，应进行心电图检查。应通过多学科团队对滥用药物患者进行随访，并定期进行血液检查和心电图检查。
