Heavy Burden of Toxic Dilated Cardiomyopathy Among Young Adults: A Retrospective Study and Review of the Literature |
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| Institution: | 1. Cardiovascular Genetics Centre, Montreal Heart Institute, Montreal, Quebec, Canada;2. Faculty of Medicine, Université de Montréal, Montreal, Quebec, Canada;3. Department of Medicine, University of Alberta, Edmonton, Alberta, Canada;4. Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada;1. Heart Centre, Department of Clinical Cardiology, Amsterdam UMC, University of Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands;2. Department of Cardiology, University Medical Centre Utrecht, Utrecht, The Netherlands;3. Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands;4. Department of Radiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands;5. Department of Radiology, University Medical Centre Utrecht, Utrecht, The Netherlands;1. Department of Cardiology, First Affiliated Hospital of Harbin Medical University, Harbin, China;2. College of Pharmacy, Harbin Medical University—Daqing, Daqing, China;3. Department of Cardiology, Second Affiliated Hospital of Harbin Medical University, Harbin, China;4. Key Laboratory of Myocardial Ischemia, Harbin Medical University, Ministry of Education, Harbin, Heilongjiang, China;1. ICES (formerly, Institute for Clinical Evaluative Sciences), Toronto, Ontario, Canada;2. Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada;3. Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada;4. Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada;5. Ted Rogers Centre for Heart Research, Toronto, Ontario, Canada |
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| Abstract: | BackgroundDilated cardiomyopathy (DCM) is a well described entity for heart failure (HF) with reduced left ventricular ejection fraction (LVEF). Recently, drugs and other substance of abuse have been recognised as potential triggers for DCM. The aim of this study was to assess the survival in patients ≤ 65 years of age with toxic cardiomyopathy (TCM). Left ventricular remodelling and the potential usefulness of left ventricular assist devices (LVADs) was also assessed.MethodsThis was a single-centre retrospective study from January 2003 to August 2019 of 553 patients ≤ 65 years old with LVEF < 40% at a tertiary-care cardiology centre.ResultsA total of 201 patients (36%) had a diagnosis of idiopathic DCM. Further analysis identified 38 patients (19%) for which a TCM was the most likely etiology (amphetamine 50%], cocaine 37%], anabolic steroids 8%], and energy drinks 5%]). Despite a mean LVEF of 17 ± 8% at presentation, most patients (n = 27; 71%) had event-free survival with guideline-directed medical therapy, and 61% (n = 23) recovered an LVEF ≥ 40% after a median follow-up of 21 ± 23 months. Seven patients (18%) required an LVAD and 1 patient (3%) a transplantation. All LVADs were explanted or decommissioned after partial or complete LVEF recovery after a median support time of 11 ± 4 months.ConclusionsTCM induced by substance abuse is a frequent cause of HF, accounting for almost 20% of patients ≤ 65 years of age with DCM of unknown etiology. Treatment must be tailored on an individual basis. Mechanical circulatory support demonstrated its usefulness in carefully selected patients. |
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