title: Clinical Characteristics and Outcomes of Patients with Amphetamine-Associated Cardiomyopathy in South Auckland, New Zealand.
abstract: BACKGROUND
  Amphetamine-associated cardiomyopathy (AAC) is becoming an increasingly recognised entity. The characteristics and outcomes of these patients are poorly understood.
  
  
  METHODS
  Thirty patients admitted with heart failure and echocardiographic evidence of cardiomyopathy between 2005 and 2014 and who had a documented history of amphetamine abuse that was considered an important factor in the causation of their cardiomyopathy were retrospectively identified.
  
  
  RESULTS
  Mean age at presentation was 40±10 years with a male predominance (n=25, 83%). The majority were of indigenous Maori ethnicity. At presentation, four patients were in cardiogenic shock. Five patients required intensive care unit (ICU) admission for inotropic support and mechanical ventilation. Fifteen had severe left ventricular (LV) dilation (mean LV end-diastolic dimension 6.8±1.0cm) and all patients had severe LV dysfunction (mean LV ejection fraction 22±8%). Despite optimal heart failure therapy, LV size remained significantly dilated with minimal improvement in LV function. During median follow-up of 18 months, five patients died from end-stage heart failure and 17 had at least one readmission with decompensated heart failure.
  
  
  CONCLUSIONS
  Amphetamine-associated cardiomyopathy was seen predominantly in young indigenous Maori men. They presented with severe cardiomyopathy, often requiring ICU admission. Severe LV dilation and significant LV dysfunction persisted despite treatment and mortality was high.
authors.affiliation: Department of Cardiology, Middlemore Hospital, Otahuhu, Auckland, New Zealand.
authors.forename: Shaw-Hua Anthony
authors.initials: SA
authors.lastname: Kueh
authors.affiliation: Department of Cardiology, Middlemore Hospital, Otahuhu, Auckland, New Zealand.
authors.forename: Ruvin S
authors.initials: RS
authors.lastname: Gabriel
authors.affiliation: Department of Cardiology, Middlemore Hospital, Otahuhu, Auckland, New Zealand.
authors.forename: Mayanna
authors.initials: M
authors.lastname: Lund
authors.affiliation: Department of Cardiology, Middlemore Hospital, Otahuhu, Auckland, New Zealand.
authors.forename: Tim
authors.initials: T
authors.lastname: Sutton
authors.affiliation: Department of Cardiology, Middlemore Hospital, Otahuhu, Auckland, New Zealand.
authors.forename: Joshua
authors.initials: J
authors.lastname: Bradley
authors.affiliation: Department of Cardiology, Middlemore Hospital, Otahuhu, Auckland, New Zealand.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Kerr
authors.affiliation: Department of Cardiology, Middlemore Hospital, Otahuhu, Auckland, New Zealand. Electronic address: JenLi.Looi@middlemore.co.nz.
authors.forename: Jen-Li
authors.initials: JL
authors.lastname: Looi
mesh_terms: D000328:Adult; D000661:Amphetamine / Q000009:adverse effects*; D019969:Amphetamine-Related Disorders / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D009202:Cardiomyopathies / Q000139:chemically induced / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D012737:Sex Factors
chemical_list: D000661:Amphetamine
keywords: Amphetamine; Cardiogenic shock; Cardiomyopathy; Echocardiography; Heart failure; Pathophysiology