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      Long term effects of cocaine on the heart assessed by cardiovascular magnetic resonance at 3T

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          Abstract

          Background

          Cocaine is an addictive, sympathomimetic drug with potentially lethal effects. The prevalence and features of cocaine cardiotoxicity are not well known. We aimed to assess these effects using a comprehensive cardiovascular magnetic resonance (CMR) protocol in a large group of asymptomatic cocaine users.

          Methods

          Consecutive (n = 94, 81 males, 36.6 ±7 years), non-selected, cocaine abusers were recruited and had a medical history, examination, ECG, blood test and CMR. The CMR study included measurement of left and right ventricular (LV, RV) dimensions and ejection fraction (EF), sequences for detection of myocardial oedema and late gadolinium enhancement (LGE). Images were compared to a cohort of healthy controls.

          Results

          Years of regular cocaine use were 13.9 ± 9. When compared to the age-matched healthy cohort, the cocaine abusers had increased LV end-systolic volume, LV mass index and RV end-systolic volume, with decreased LVEF and RVEF. No subject had myocardial oedema, but 30% had myocardial LGE indicating myocardial damage.

          Conclusions

          CMR detected cardiovascular disease in 71% of this cohort of consecutive asymptomatic cocaine abusers and mean duration of abuse was related to probability of LV systolic dysfunction.

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          Most cited references38

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          2007 Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC).

          G. Mancia, G. De Backer, A. Dominiczak … (2006)
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            Cardiovascular magnetic resonance, fibrosis, and prognosis in dilated cardiomyopathy.

            Ravi G Assomull, Sanjay Prasad, Jonathan C. Lyne … (2006)
            We studied the prognostic implications of midwall fibrosis in dilated cardiomyopathy (DCM) in a prospective longitudinal study. Risk stratification of patients with nonischemic DCM in the era of device implantation is problematic. Approximately 30% of patients with DCM have midwall fibrosis as detected by late gadolinium-enhancement (LGE) cardiovascular magnetic resonance (CMR), which may increase susceptibility to arrhythmia and progression of heart failure. Consecutive DCM patients (n = 101) with the presence or absence of midwall fibrosis were followed up prospectively for 658 +/- 355 days for events. Midwall fibrosis was present in 35% of patients and was associated with a higher rate of the predefined primary combined end point of all-cause death and hospitalization for a cardiovascular event (hazard ratio 3.4, p = 0.01). Multivariate analysis showed midwall fibrosis as the sole significant predictor of death or hospitalization. However, there was no significant difference in all-cause mortality between the 2 groups. Midwall fibrosis also predicted secondary outcome measures of sudden cardiac death (SCD) or ventricular tachycardia (VT) (hazard ratio 5.2, p = 0.03). Midwall fibrosis remained predictive of SCD/VT after correction for baseline differences in left ventricular ejection fraction between the 2 groups. In DCM, midwall fibrosis determined by CMR is a predictor of the combined end point of all-cause mortality and cardiovascular hospitalization, which is independent of ventricular remodeling. In addition, midwall fibrosis by CMR predicts SCD/VT. This suggests a potential role for CMR in the risk stratification of patients with DCM, which may have value in determining the need for device therapy.
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              Delayed enhancement cardiovascular magnetic resonance assessment of non-ischaemic cardiomyopathies.

              R J Judd, JERI KIM, Udo Sechtem … (2005)
              Non-ischaemic cardiomyopathies (NICMs) are chronic, progressive myocardial diseases with distinct patterns of morphological, functional, and electrophysiological changes. In the setting of cardiomyopathy (CM), determining the exact aetiology is important because the aetiology is directly related to treatment and patient survival. Determining the exact aetiology, however, can be difficult using currently available imaging techniques, such as echocardiography, radionuclide imaging or X-ray coronary angiography, since overlap of features between CMs may be encountered. Cardiovascular magnetic resonance (CMR) imaging has recently emerged as a new non-invasive imaging modality capable of providing high-resolution images of the heart in any desired plane. Delayed contrast enhanced CMR (DE-CMR) can be used for non-invasive tissue characterization and may hold promise in differentiating ischaemic from NICMs, as the typical pattern of hyperenhancement can be classified as 'ischaemic-type' or 'non-ischaemic type' on the basis of pathophysiology of ischaemia. This article reviews the potential of DE-CMR to distinguish between ischaemic and NICM as well as to differentiate non-ischaemic aetiologies. Rather than simply describing various hyperenhancement patterns that may occur in different disease states, our goal will be (i) to provide an overall imaging approach for the diagnosis of CM and (ii) to demonstrate how this approach is based on the underlying relationships between contrast enhancement and myocardial pathophysiology.
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                Author and article information

                Contributors
                Alicia M Maceira
                Carmen Ripoll
                Juan Cosin-Sales
                Begoña Igual
                Mirella Gavilan
                Jose Salazar
                Vicente Belloch
                Dudley J Pennell
                Journal
                Journal ID (nlm-ta): J Cardiovasc Magn Reson
                Journal ID (iso-abbrev): J Cardiovasc Magn Reson
                Title: Journal of Cardiovascular Magnetic Resonance
                Publisher: BioMed Central
                ISSN (Print): 1097-6647
                ISSN (Electronic): 1532-429X
                Publication date Collection: 2014
                Publication date (Electronic): 23 April 2014
                Volume: 16
                Issue: 1
                Page: 26
                Affiliations
                [1 ]Cardiac Imaging Unit, ERESA Medical Center, Valencia, RIC, Spain
                [2 ]Addictions Treatment Unit of Campanar, La Fe Hospital, Valencia, Spain
                [3 ]Department of Cardiology, Hospital Arnau de Vilanova, Valencia, Spain
                [4 ]Department of Psychiatry, Consorcio Hospital General, Valencia, CIBERSAM, Spain
                [5 ]NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital & Imperial College, London, UK
                Article
                Publisher ID: 1532-429X-16-26
                DOI: 10.1186/1532-429X-16-26
                PMC ID: 4026110
                PubMed ID: 24758161
                SO-VID: e316c4d8-a9f0-4180-95bf-055656f94f9d
                Copyright © Copyright © 2014 Maceira et al.; licensee BioMed Central Ltd.
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 15 September 2013
                Date accepted : 24 March 2014
                Categories
                Subject: Research

                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: cocaine,magnetic resonance,heart failure
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: cocaine, magnetic resonance, heart failure

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