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

Abstract

BackgroundCocaine 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.MethodsConsecutive (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.ResultsYears 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.ConclusionsCMR 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.

Asymptomatic Cocaine Abuse ― Myocardial Tissue Characterization Using Cardiac Biomarkers and Cardiovascular Magnetic Resonance Imaging ―

“…Furthermore, neither the T2 ratio nor native myocardial T1 as indicators of diffuse myocardial edema were elevated compared with healthy controls (Table 4). While these data are in line with Maceira et al, 13 Aquaro et al found edema in 47% (n=14) of their patients. Given that 43% (n=13) of the Aquaro et al patients had positive urine assay for cocaine metabolites at the time of CMR, the authors suggested a correlation between recent cocaine use and the presence of focal edema.…”

“…14 In contrast, Maceira et al observed a significant increase of LVESVi (30±8 mL/m 2 vs. 26±5 mL/m 2 ; P≤0.01) and LV mass index (76±15 g/m 2 vs. 69±4 g/m 2 ; P≤0.01) as well as a significant decrease in LVEF (59±5% vs. 68±4%; P≤0.01) compared with their healthy control group. 13 Nevertheless, all obtained LVEDVi, LVESVi, LV mass index and LVEF in CA in the present and the 2 recent studies were within the normal range according to recently established reference values for CMR. 34 Furthermore, we observed mild diastolic dysfunction only in 2 CA, which was not associated with increased LV mass or hypertension.…”

“…While only 1 CA in their cohort presented with an ischemic pattern of LGE in terms of sub-endocardial LGE, all other CA had a non-ischemic pattern in terms of mid-myocardial LGE or LGE located at the inferior RV insertion point. 13 In contrast, Aquaro et al noted LGE in 73% (n=22) of their patients. While 68% (n=15) of these patients had a non-ischemic LGE pattern, a significant number of patients (32%; n=7) presented with an ischemic pattern.…”

Cardiovascular consequences of cocaine use

“…Using cardiovascular magnetic resonance imaging, Maceira et al [60] found that approximately 30% of nearly 100 long-term asymptomatic cocaine users had evidence of cardiovascular disease. Similarly, Sharma et al [34] performed 12-lead electrocardiograms (ECGs) in nearly 100 cocaine-dependent subjects and found long-lasting effects of cocaine use on cardiac conduction and the autonomic nervous system that are likely to increase the risk of adverse cardiovascular events even between episodes of cocaine use.…”

“…Increased QT interval is most common, but prolongation of QRS duration and PR interval may also be noted. Investigators have also noted increased left ventricular end-systolic volume, left ventricular mass index, and right ventricular end-systolic volume with decreased left and right ventricular ejection fraction with long-term use [60].…”