Department of Cardiology, The Alfred Hospital,, Melbourne, Victoria, Australia.
Department of Intensive Care, The Alfred Hospital,, Melbourne, Victoria, Australia.
Intern Med J. 2016 Jun;46(6):723-7. doi: 10.1111/imj.13050.
Methamphetamine abuse is a growing public health problem, and increasing numbers of patients are admitted with methamphetamine-associated cardiomyopathy (MAC).
We sought to characterise the patterns of this disease and identify predictors of recovery.
We retrospectively studied consecutive patients diagnosed with MAC between January 2006 and July 2015.
We identified 20 patients (14 males, 6 females) with mean age 35 ± 9 years. Most had very severe systolic dysfunction (mean left ventricular ejection fraction (LVEF) 19.7 ± 11.4%) at presentation with 14 requiring inotropes and 5 requiring mechanical support. The pattern of systolic dysfunction was global in 14 patients, while 6 patients had a 'reverse Takotsubo' (RT) pattern with severely hypokinetic basal-mid segments and apical preservation. RT patients were predominantly female, had a short history of methamphetamine abuse and had higher cardiac enzyme levels. Patients with global dysfunction tended to have mid-wall fibrosis on cardiac magnetic resonance imaging. On follow-up transthoracic echocardiography, 6 out of 19 (32%) had normalisation of LVEF (LVEF ≥ 50%) within 6 weeks. Smaller left ventricular and left atrial size, shorter duration of methamphetamine use and RT pattern appeared to predict early recovery.
A subset of MAC patients, particularly those with a RT pattern and lesser ventricular dilatation have the potential for early recovery of ventricular function. By contrast, those with evidence of myocardial fibrosis and ventricular enlargement have limited scope for recovery.
冰毒滥用是一个日益严重的公共卫生问题，越来越多的患者因冰毒相关心肌病（MAC）入院。
我们旨在描述这种疾病的模式，并确定其恢复的预测因素。
我们回顾性研究了 2006 年 1 月至 2015 年 7 月期间连续诊断为 MAC 的患者。
我们确定了 20 名患者（14 名男性，6 名女性），平均年龄为 35±9 岁。大多数患者在就诊时存在严重的收缩功能障碍（平均左心室射血分数（LVEF）为 19.7±11.4%），14 名患者需要正性肌力药，5 名患者需要机械支持。14 名患者的收缩功能障碍呈弥漫性，6 名患者呈“反向 Takotsubo”（RT）模式，基底-中段严重运动障碍，心尖部保留。RT 患者主要为女性，冰毒滥用史短，心肌酶水平较高。具有弥漫性功能障碍的患者在心脏磁共振成像上倾向于存在中壁纤维化。在随访的经胸超声心动图上，19 名患者中有 6 名（32%）在 6 周内 LVEF（LVEF≥50%）正常化。较小的左心室和左心房大小、较短的冰毒使用时间和 RT 模式似乎可以预测早期恢复。
MAC 患者的一部分，特别是那些 RT 模式和较小心室扩张的患者，具有早期恢复心室功能的潜力。相比之下，那些有心肌纤维化和心室扩大证据的患者恢复的可能性有限。
