Possible association between 3,4-methylenedioxymethamphetamine abuse and valvular heart disease.
Valvular heart disease, inducing valvular regurgitation, has been described in users of drugs such as anorectic agents and ergot derivates. 3,4-Methylenedioxymethamphetamine (MDMA; "ecstasy") also leads in vitro to the proliferation of cardiac valvular interstitial cells by activation of the 5-hydroxytryptamine 2B receptor. The aim of this study was to determine the occurrence of valvulopathy in young adults taking MDMA. Twenty-nine subjects using or having used MDMA and 29 gender- and age-matched controls were blindly evaluated with echocardiography. Eight subjects (28%) who took MDMA had abnormal echocardiographic results using the United States Food and Drug Administration's criteria for appetite suppressant-induced valvular heart disease, compared with none in the control group (p = 0.0045). Six (21%) subjects had mitral regurgitation of 1/4 and 4 (14%) of > or =2/4, compared with none in the control group (p = 0.002). The mean mitral regurgitant area ratios (jet/atrium) were 12 +/- 9.8% and 5 +/- 1.3%, respectively (p = 0.007). Tricuspid regurgitation > or =2/4 was present in 13 MDMA users (45%) and absent in controls (p <0.001). The mean tricuspid regurgitant area ratios were 19 +/- 9.5% and 9 +/- 4.5%, respectively (p <0.001). Four MDMA users (14%) had mild aortic regurgitation (p = 0.11). Valvular "strands" were present in 6 MDMA users (21%) and in none of the controls (p = 0.02). In conclusion, MDMA may lead to mild to moderate valvular heart disease and valvular strands.
Droogmans
Steven
S
Department of Cardiology, Universitair Ziekenhuis Brussel, Brussels, Belgium. steven_droogmans@yahoo.com
Cosyns
Bernard
B
D'haenen
Hugo
H
Creeten
Edwin
E
Weytjens
Caroline
C
Franken
Philippe R
PR
Scott
Benjamin
B
Schoors
Danny
D
Kemdem
Arsène
A
Close
Laurent
L
Vandenbossche
Jean-Luc
JL
Bechet
Serge
S
Van Camp
Guy
G
D000328:Adult; D004305:Dose-Response Relationship, Drug; D005260:Female; D006213:Hallucinogens / Q000009:adverse effects*; D006349:Heart Valve Diseases / Q000139:chemically induced*; D006801:Humans; D016015:Logistic Models; D008297:Male; D018817:N-Methyl-3,4-methylenedioxyamphetamine / Q000009:adverse effects*; D019966:Substance-Related Disorders / Q000150:complications*
D006213:Hallucinogens; D018817:N-Methyl-3,4-methylenedioxyamphetamine