Clinical Characteristics and Outcome of Methamphetamine-Associated Pulmonary Arterial Hypertension and Dilated Cardiomyopathy
Clinical Characteristics and Outcome of Methamphetamine-Associated Pulmonary Arterial Hypertension and Dilated Cardiomyopathy
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DOI：
10.1016/j.jchf.2017.10.006
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发表时间：
2018-03-01
影响因子：
13
通讯作者：
Crawford, Michael H.
中科院分区：
文献类型：
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作者：
Zhao, Susan X.;Kwong, Calvin;Crawford, Michael H.
本研究试图描述甲基苯丙胺相关肺动脉高压（MA-PAH）和心肌病（MA-CMP）患者的特征，与MA对照（MA-CTL），心脏结构正常的使用者，目的是确定这些疾病的风险因素。背景MA-PAH和MA-CMP是MA使用者中2种知之甚少的心脏并发症。方法我们回顾性研究了50例MA-PAH的临床特征和结局，结果中位随访20.0个月（四分位距[IQR]：7.6 ~ 42.6个月）后，MA-PAH组、MA-CMP组和MA-CTL组的全因死亡率分别为18.0%、15.2%和4.5%（p < 0.001）。MA-PAH组的女性（58%）多于MA-CMP组（14%; p < 0.001）和MA-CTL组（42%; p = 0.028），而MA-CMP组主要是男性（86% vs. MA-CTL组58%; p < 0.001）。MA-CMP组高血压（p < 0.001）和酗酒（p < 0.001）的发生率高于MA-CTL组。Logistic回归分析确定男性、酗酒和高血压为MA-CMP的独立相关因素，调整后OR为3.791（95%置信区间[CI]：2.508 - 5.730），OR为2.959（95% CI：2.084 - 4.203），OR为2.111（95% CI：1.486 ~ 2.999），而女性是唯一与MA-PAH相关的因素。男性、高血压和酗酒与MA-CMP密切相关，而女性和其他未知因素可能影响MA-PAH的发展。这项研究增加了对MA相关心脏并发症的理解，并强调了未来研究的方向。由Elsevier代表美国心脏病学会基金会发布。
OBJECTIVES This study sought to characterize patients with methamphetamine-associated pulmonary arterial hypertension (MA-PAH) and cardiomyopathy (MA-CMP), to compare with MA controls (MA-CTL), users with structurally normal hearts, with the aim of identifying risk factors for these conditions.BACKGROUND MA-PAH and MA-CMP are 2 poorly understood cardiac complications in MA users.METHODS We retrospectively studied the clinical characteristics and outcomes of 50 MA-PAH, 296 MA-CMP, and 356 MA-CTL patients, whom we evaluated between 2010 and 2017.RESULTS After a median follow-up of 20.0 months (interquartile range [IQR]: 7.6 to 42.6 months), all-cause mortality was 18.0% for MA-PAH, 15.2% for MA-CMP, and 4.5% for MA-CTL group (p < 0.001). More women (58%) were in the MA-PAH group than in the MA-CMP (14%; p < 0.001) and MA-CTL (42%; p = 0.028) groups, whereas the MA-CMP group was predominantly male (86% vs. 58% in the MA-CTL group; p < 0.001). More MA-CMP patients had hypertension (p < 0.001) or alcoholism (p < 0.001) than MA-CTL patients. Logistic regression analyses identified male sex, alcoholism, and hypertension as independent factors associated with MA-CMP with the following respective adjusted odds ratios (OR) of 3.791 (95% confidence interval [CI]: 2.508 to 5.730), OR of 2.959 (95% CI: 2.084 to 4.203), and OR of 2.111 (95% CI: 1.486 to 2.999), whereas female sex was the only factor associated with MA-PAH.CONCLUSIONS Both MA-PAH and MA-CMP patients carried significant disease burden and mortality risk. Male sex, hypertension, and alcoholism were strongly associated with MA-CMP, whereas female sex and other unknown factors may influence development of MA-PAH. This study adds to the understanding of MA-associated cardiac complications and highlights directions for future investigation. Published by Elsevier on behalf of the American College of Cardiology Foundation.