Methylenedioxymethamphetamine (ecstasy)-related myocardial hypertrophy: an autopsy study.
BACKGROUND
Myocardial hypertrophy is a well-recognized complication of cocaine and methamphetamine abuse and is a strong, independent risk factor for sudden death, myocardial infarction, and congestive heart failure. We sought to determine if use of MDMA (methylenedioxyamphetamine or "ecstasy") is associated with myocardial hypertrophy at death.


RESULTS
A matched, retrospective study using medical examiner (ME) death reports. Consecutive MDMA positive (+) and MDMA negative (-) deaths identified from MEs in 10 states and a local county, respectively. Five MDMA(-) cases were matched to each MDMA(+) case for age, sex, and ethnicity. MDMA(+) cases were confirmed using GC/MS and other drugs of abuse (e.g., cocaine and methamphetamine) were absent. Matched MDMA(-) cases were trauma fatalities with intact hearts and blood negative for all illicit stimulants. Cardiac weights were compared between the two groups. Twenty seven MDMA(+) deaths and 135 matched MDMA(-) deaths were enrolled. Mean age was 20 years (range 16--33 years); 44% were female. 70.4% were Caucasian, 14.8% African-American, 11.1% Asian, and 3.7% Hispanic. Mean heart weight of MDMA(+) fatalities was 315.7 and 277.2g for MDMA(-) fatalities (Diff=38.5 g; 95% CI=18.3--8.7). Multivariate analysis revealed that MDMA(+) fatalities were more likely to have an enlarged heart (OR=18.3; 95% CI=3.6--1.6).


CONCLUSIONS
The findings of this study suggest that MDMA users might also be at risk for myocardial hypertrophy and possible cardiac toxicity, similar to other stimulants.
Patel
Manish M
MM
Georgia Poison Control System, 3661 Briarcliff, Atlanta, GA 30322, USA; Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA 30333, USA. mmpatel@emory.edu
Belson
Martin G
MG
Wright
David
D
Lu
Huang
H
Heninger
Michael
M
Miller
Michael A
MA
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D019969:Amphetamine-Related Disorders / Q000453:epidemiology* / Q000473:pathology*; D001344:Autopsy; D006332:Cardiomegaly / Q000139:chemically induced* / Q000401:mortality / Q000473:pathology*; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D018817:N-Methyl-3,4-methylenedioxyamphetamine / Q000009:adverse effects*; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
D018817:N-Methyl-3,4-methylenedioxyamphetamine