Kewcharoen Jakrin, Chang Andrew K, Parwani Purvi, Fraser Gary, Bharadwaj Aditya, Seliem Ahmed, Tran Diane, Stoletniy Liset, Sakr Antoine, Abramov Dmitry
Department of Medicine, Division of Cardiology, Loma Linda University Medical Center, Loma Linda, CA, USA.
Cardiol Res. 2022 Apr;13(2):81-87. doi: 10.14740/cr1364. Epub 2022 Apr 5.
Methamphetamines are a common cause of systolic heart failure (HF). There are limited data on the prognosis associated with hospitalizations for decompensated HF in the setting of methamphetamine use. We aimed to evaluate patient characteristics and outcomes among patients admitted with decompensated HF who had positive drug screens for amphetamines as well as to determine whether any parameters from transthoracic echocardiogram (TTE) can predict outcomes in this population.
This was a retrospective cohort study of consecutive adult patients admitted to the Loma Linda Medical Center who had an active hospital problem of acute on chronic systolic (or systolic and diastolic) HF from 2013 to 2018. Electronic medical records were mined for relevant patient data. Methamphetamine-associated heart failure (MethHF) group was defined as those with an admission urine drug screen (UDS) that was positive for methamphetamines, whereas non-MethHF was defined by patients with negative methamphetamine on UDS or UDS was not done on physician's discretion. The primary outcomes of the study were 30-day composite outcome (defined as combined all-cause readmission and all-cause mortality), 365-day all-cause mortality, and length of stay (LOS). Propensity score weighting for these outcomes was performed using demographics, laboratory and clinical variables, and left ventricular ejection fraction (LVEF) as covariates. TTE parameters from presentation were also evaluated to determine if any had prognostic implications.
A total of 1,655 patients were included (101 patients with positive urine methamphetamine and 1,554 patients without). Patients with MethHF were younger, more likely to be male, had fewer comorbidities, had lower LVEF, and were more likely to have right ventricular systolic dysfunction. In propensity-weighted analyses, there were no significant differences in LOS, 30-day composite outcome, or 365-day mortality between the MethHF and non-MethHF group in (P > 0.05 for all). Presence of at least moderate tricuspid valve regurgitation (TR) was the only TTE predictor of 30-day composite outcome (odds ratio (OR) = 4.67, 95% confidence interval (CI): 1.5 - 14.50, P < 0.01) and 365-day mortality (OR = 4.67, 95% CI: 1.5 - 14.50, P < 0.01) in the MethHF group.
Patients with MethHF admitted for decompensated HF had similar outcomes compared to non-MethHF after adjusting for baseline characteristics. TR is the only TTE value to predict outcomes in this population.
甲基苯丙胺是收缩性心力衰竭（HF）的常见病因。关于甲基苯丙胺使用情况下因失代偿性HF住院的预后数据有限。我们旨在评估因失代偿性HF入院且苯丙胺药物筛查呈阳性的患者的特征和结局，并确定经胸超声心动图（TTE）的任何参数是否可预测该人群的结局。
这是一项对2013年至2018年连续入住洛马林达医疗中心且患有急性慢性收缩性（或收缩性和舒张性）HF的成年患者的回顾性队列研究。从电子病历中挖掘相关患者数据。甲基苯丙胺相关性心力衰竭（MethHF）组定义为入院尿液药物筛查（UDS）甲基苯丙胺呈阳性的患者，而非MethHF组定义为UDS甲基苯丙胺呈阴性或根据医生判断未进行UDS的患者。该研究的主要结局为30天综合结局（定义为全因再入院和全因死亡率的综合）、365天全因死亡率和住院时间（LOS）。使用人口统计学、实验室和临床变量以及左心室射血分数（LVEF）作为协变量对这些结局进行倾向评分加权。还评估了入院时的TTE参数，以确定是否有任何参数具有预后意义。
共纳入1655例患者（101例尿液甲基苯丙胺呈阳性，1554例呈阴性）。MethHF组患者更年轻，男性比例更高，合并症更少，LVEF更低，且更易出现右心室收缩功能障碍。在倾向加权分析中，MethHF组和非MethHF组在LOS、30天综合结局或365天死亡率方面无显著差异（所有P>0.05）。至少存在中度三尖瓣反流（TR）是MethHF组30天综合结局（优势比（OR）=4.67，95%置信区间（CI）：1.5 - 14.50，P<0.01）和365天死亡率（OR = 4.67，95%CI：1.5 - 14.50，P<0.01）的唯一TTE预测指标。
在调整基线特征后，因失代偿性HF入院的MethHF患者与非MethHF患者的结局相似。TR是该人群中预测结局的唯一TTE值。
