title: Methamphetamine-associated cardiomyopathy: patterns and predictors of recovery.
abstract: BACKGROUND
  Methamphetamine abuse is a growing public health problem, and increasing numbers of patients are admitted with methamphetamine-associated cardiomyopathy (MAC).
  
  
  OBJECTIVE
  We sought to characterise the patterns of this disease and identify predictors of recovery.
  
  
  METHODS
  We retrospectively studied consecutive patients diagnosed with MAC between January 2006 and July 2015.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Cardiology, The Alfred Hospital,, Melbourne, Victoria, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Voskoboinik
authors.affiliation: Department of Intensive Care, The Alfred Hospital,, Melbourne, Victoria, Australia.
authors.forename: J F
authors.initials: JF
authors.lastname: Ihle
authors.affiliation: Department of Cardiology, The Alfred Hospital,, Melbourne, Victoria, Australia.
authors.forename: J E
authors.initials: JE
authors.lastname: Bloom
authors.affiliation: Department of Cardiology, The Alfred Hospital,, Melbourne, Victoria, Australia.|Heart Failure Research, Baker IDI, Melbourne, Victoria, Australia.
authors.forename: D M
authors.initials: DM
authors.lastname: Kaye
mesh_terms: D000328:Adult; D009202:Cardiomyopathies / Q000139:chemically induced / Q000150:complications* / Q000000981:diagnostic imaging*; D004452:Echocardiography; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008694:Methamphetamine / Q000009:adverse effects*; D009206:Myocardium / Q000473:pathology; D012189:Retrospective Studies; D013318:Stroke Volume; D054549:Takotsubo Cardiomyopathy / Q000000981:diagnostic imaging*; D014739:Victoria
chemical_list: D008694:Methamphetamine
keywords: cardiomyopathy; heart failure; methamphetamine; reverse Takotsubo