O'Neill Emily, Lu Dai-Yin, Ramakrishna Satvik, Ingram Dominique, Kogelschatz Benjamin, Ryan John J, Mayeux Jennalyn, Ma Christy, Klanderud Dana, Beck Emily, Dranow Elizabeth, Hatton Nathan, Clapham Katharine
Department of Medicine, University of Utah, Salt Lake City, Utah, USA.
Division of Cardiology, University of Utah, Salt Lake City, Utah, USA.
Echocardiography. 2025 May;42(5):e70180. doi: 10.1111/echo.70180.
Methamphetamine is increasingly recognized as a cause of pulmonary arterial hypertension (PAH). This study examines whether non-invasively measured metrics of right heart function, right atrial (RA) and right ventricular (RV) strain, are more impaired in methamphetamine-associated PAH (MA-PAH) compared with idiopathic PAH (IPAH).
A retrospective cohort analysis of 51 patients with MA-PAH matched for mean pulmonary artery pressure (mPAP) with 51 patients with IPAH followed at the pulmonary hypertension clinic at the University of Utah was performed. Invasive hemodynamics and echocardiographic measures of right heart function, including RA strain and RV free wall strain, were compared.
Compared to the matched IPAH group, MA-PAH patients had lower cardiac index (2.04 ± 0.84 vs. 2.52 ± 1.07 L/min/m, p = 0.016) and higher pulmonary vascular resistance (PVR; 11.8 ± 6.8 vs. 8.9 ± 4.8 Wood units, p = 0.018). The MA-PAH group had larger RA maximal and minimal volume, lower RA reservoir strain (26.4 ± 11.7 vs. 33.4 ± 14.8 %, p = 0.011), more significant RV chamber dilation, and lower fractional area change (FAC; 21.1 ± 11.1 % vs. 34.5 ± 11.8 %, p < 0.001), compared to the IPAH group. RV e' was lower in MA-PAH (6.5 ± 2.8 cm/s vs. 8.3 ± 4.3 cm/s, p = 0.021), suggesting worse RV diastolic function and RV free wall strain was significantly more reduced compared to patients with I-PAH (17.0 ± 6.5 vs. 22.3 ± 7.2 %, p < 0.001). There were no differences in 5-year survival (p = 0.26), 6MW distance including stratification for males and females (p = 0.249 in females, p = 0.279 in males), and rehospitalization rates within 5 years of diagnosis (p = 0.70).
Despite a similar mPAP, patients with MA-PAH had more RA dilation, RV dilation, lower RV systolic/diastolic function, and worse RA and RV mechanics as assessed by strain compared to patients with I-PAH. Our findings suggest that, in addition to causing remodeling of the pulmonary vasculature, methamphetamine may have a direct cardiotoxic effect on the right heart.
甲基苯丙胺日益被认为是肺动脉高压（PAH）的一个病因。本研究旨在探讨与特发性PAH（IPAH）相比，甲基苯丙胺相关PAH（MA-PAH）患者经非侵入性测量的右心功能指标，即右心房（RA）和右心室（RV）应变，是否受损更严重。
对犹他大学肺动脉高压诊所随访的51例MA-PAH患者和51例IPAH患者进行回顾性队列分析，这两组患者的平均肺动脉压（mPAP）相匹配。比较了右心功能的有创血流动力学和超声心动图测量结果，包括RA应变和RV游离壁应变。
与匹配的IPAH组相比，MA-PAH患者的心指数较低（2.04±0.84 vs. 2.52±1.07 L/min/m²，p = 0.016），肺血管阻力（PVR）较高（11.8±6.8 vs. 8.9±4.8 Wood单位，p = 0.018）。MA-PAH组的RA最大和最小容积更大，RA储备应变较低（26.4±11.7% vs. 33.4±14.8%，p = 0.011），RV腔扩张更显著，且与IPAH组相比，面积变化分数（FAC）更低（21.1±11.1% vs. 34.5±11.8%，p < 0.001）。MA-PAH患者的RV e'较低（6.5±2.8 cm/s vs. 8.3±4.3 cm/s，p = 0.021），提示RV舒张功能较差，且与I-PAH患者相比，RV游离壁应变显著降低（17.0±6.5% vs. 22.3±7.2%，p < 0.001）。5年生存率（p = 0.26）、6分钟步行距离（包括按性别分层，女性p = 0.249，男性p = 0.279）以及诊断后5年内的再住院率（p = 0.70）均无差异。
尽管mPAP相似，但与IPAH患者相比，MA-PAH患者的RA扩张、RV扩张更明显，RV收缩/舒张功能更低，且通过应变评估的RA和RV力学更差。我们的研究结果表明，除了导致肺血管重塑外，甲基苯丙胺可能对右心有直接的心脏毒性作用。
