Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Original Article

Volume 13, Number 2, April 2022, pages 81-87

Echocardiographic Parameters and Outcomes in Methamphetamine-Associated Heart Failure: A Propensity Score-Weighted Analysis

**Table 1.** Baseline Characteristics and Transthoracic Echocardiogram of Study Participants
Variables	MethHF (n = 101)	Non-MethHF (n = 1,554)	P-value
ACEI: angiotensin-converting enzyme inhibitor; ARB: angiotensin receptor blocker; BSA: body surface area; DM: diabetes mellitus; CAD: coronary artery disease; CKD: chronic kidney disease; COPD: chronic obstructive pulmonary disease; Cr: creatinine; E/A: peak velocity blood flow from early diastole to peak velocity flow in late diastole caused by atrial contraction; IVSD: interventricular septal diameter; LA: left atrium; LVEDV: left ventricular end-diastolic volume; LVESV: left ventricular end-systolic volume; LVIDd: left ventricular internal diameter end diastole; LVIDs: left ventricular internal diameter end systole; LVPWd: left ventricular posterior wall diameter; LVEF: left ventricular ejection fraction; MethHF: methamphetamine-associated heart failure; MR: mitral valve regurgitation; Na: sodium; SBP: systolic blood pressure; RV: right ventricle; TR: tricuspid valve regurgitation.
Demographics
Male	73 (72.3%)	944 (60.7%)	0.01
Mean age	52.0 ± 10.7	65.2 ± 16.1	< 0.01
BSA	2.02 ± 0.29	1.95 ± 0.33	0.06
DM	15 (14.9%)	424 (27.3%)	< 0.01
CKD	11 (10.9%)	348 (22.4%)	< 0.01
CAD	14 (13.9%)	496 (31.9%)	< 0.01
COPD	10 (9.9%)	146 (9.4%)	0.49
Admission Na	137.5 ± 4.6	137.8 ± 5.1	0.61
Admission Cr	1.3 ± 0.7	1.7 ± 1.6	< 0.01
Mean admission SBP	136.8 ± 25.7	129.3 ± 25.8	< 0.01
Mean discharge SBP	118.1 ± 20.1	116.4 ± 18.7	0.36
Echocardiogram variables
LVEF	20.6 ± 13.1	30.3 ± 18.1	< 0.01
IVSD	1.25 ± 0.30	1.22 ± 0.34	0.41
LVPWd	1.23 ± 0.26	1.13 ± 0.24	< 0.01
LVIDd/BSA	3.00 ± 0.65	2.87 ± 0.65	0.052
LVIDs/BSA	2.60 ± 0.69	2.37 ± 0.73	< 0.01
LVEDV/BSA	82.7 ± 29.4	73.1 ± 28.5	< 0.01
LVESV/BSA	52.0 ± 24.8	43.0 ± 23.8	< 0.01
LA diameter	5.92 ± 0.89	5.69 ± 1.1	0.06
E/A ratio	1.79 ± 0.92	1.58 ± 0.90	0.09
TR velocity	2.88 ± 0.58	2.91 ± 0.51	0.68
Greater or equal to moderate RV systolic dysfunction	56 (62.2%)	541 (37.8%)	< 0.01
Greater or equal to moderate MR	34 (36.6%)	462 (32.0%)	0.21
Greater or equal to moderate TR	30 (32.6%)	419 (29.0%)	0.26
Discharge medication
Any dose
ACEI/ARB	67 (66.3%)	858 (55.2%)	0.02
Beta-blocker	80 (79.2%)	1134 (73.0%)	0.10
Spironolactone	11 (10.9%)	217 (14.0%)	0.24
Greater than 50% target dose
ACEI	16 (15.8%)	242 (15.6%)	0.52
Beta-blocker	26 (25.7%)	393 (25.3%)	0.50
Spironolactone	10 (9.9%)	171 (11.0%)	0.44

Table 1. Baseline Characteristics and Transthoracic Echocardiogram of Study Participants

Variables

MethHF (n = 101)

Non-MethHF (n = 1,554)

P-value

ACEI: angiotensin-converting enzyme inhibitor; ARB: angiotensin receptor blocker; BSA: body surface area; DM: diabetes mellitus; CAD: coronary artery disease; CKD: chronic kidney disease; COPD: chronic obstructive pulmonary disease; Cr: creatinine; E/A: peak velocity blood flow from early diastole to peak velocity flow in late diastole caused by atrial contraction; IVSD: interventricular septal diameter; LA: left atrium; LVEDV: left ventricular end-diastolic volume; LVESV: left ventricular end-systolic volume; LVIDd: left ventricular internal diameter end diastole; LVIDs: left ventricular internal diameter end systole; LVPWd: left ventricular posterior wall diameter; LVEF: left ventricular ejection fraction; MethHF: methamphetamine-associated heart failure; MR: mitral valve regurgitation; Na: sodium; SBP: systolic blood pressure; RV: right ventricle; TR: tricuspid valve regurgitation.

Demographics

Male

73 (72.3%)

944 (60.7%)

0.01

Mean age

52.0 ± 10.7

65.2 ± 16.1

< 0.01

BSA

2.02 ± 0.29

1.95 ± 0.33

0.06

15 (14.9%)

424 (27.3%)

< 0.01

CKD

11 (10.9%)

348 (22.4%)

< 0.01

CAD

14 (13.9%)

496 (31.9%)

< 0.01

COPD

10 (9.9%)

146 (9.4%)

0.49

Admission Na

137.5 ± 4.6

137.8 ± 5.1

0.61

Admission Cr

1.3 ± 0.7

1.7 ± 1.6

< 0.01

Mean admission SBP

136.8 ± 25.7

129.3 ± 25.8

< 0.01

Mean discharge SBP

118.1 ± 20.1

116.4 ± 18.7

0.36

Echocardiogram variables

LVEF

20.6 ± 13.1

30.3 ± 18.1

< 0.01

IVSD

1.25 ± 0.30

1.22 ± 0.34

0.41

LVPWd

1.23 ± 0.26

1.13 ± 0.24

< 0.01

LVIDd/BSA

3.00 ± 0.65

2.87 ± 0.65

0.052

LVIDs/BSA

2.60 ± 0.69

2.37 ± 0.73

< 0.01

LVEDV/BSA

82.7 ± 29.4

73.1 ± 28.5

< 0.01

LVESV/BSA

52.0 ± 24.8

43.0 ± 23.8

< 0.01

LA diameter

5.92 ± 0.89

5.69 ± 1.1

0.06

E/A ratio

1.79 ± 0.92

1.58 ± 0.90

0.09

TR velocity

2.88 ± 0.58

2.91 ± 0.51

0.68

Greater or equal to moderate RV systolic dysfunction

56 (62.2%)

541 (37.8%)

< 0.01

Greater or equal to moderate MR

34 (36.6%)

462 (32.0%)

0.21

Greater or equal to moderate TR

30 (32.6%)

419 (29.0%)

0.26

Discharge medication

Any dose

ACEI/ARB

67 (66.3%)

858 (55.2%)

0.02

Beta-blocker

80 (79.2%)

1134 (73.0%)

0.10

Spironolactone

11 (10.9%)

217 (14.0%)

0.24

Greater than 50% target dose

ACEI

16 (15.8%)

242 (15.6%)

0.52

Beta-blocker

26 (25.7%)

393 (25.3%)

0.50

Spironolactone

10 (9.9%)

171 (11.0%)

0.44

**Table 2.** Differences in Echocardiographic Adjusting for Demographics Using the Non-Methamphetamine-Associated Heart Failure as Reference
Variables	Mean differences (95% CI)	P-value
LVEF	5.37 (2.81 - 7.64)	< 0.001
LVIDd/BSA	0.11 (-0.03 - 0.26)	0.11
LVIDs/BSA	0.17 (0.01 - 0.33)	0.04
EDV/BSA	4.33 (-1.86 - 10.33)	0.17
ESV/BSA	4.33 (-0.74 - 9.39)	0.09
LA diameter	0.196 (-0.60 - 0.45)	0.13
E/A ratio	-0.95 (-0.32 - 0.13)	0.41
TR velocity	0.05 (-0.08 - 0.17)	0.44
BSA: body surface area; CI: confidence interval; E/A: peak velocity blood flow from early diastole to peak velocity flow in late diastole caused by atrial contraction; IVSD: interventricular septal diameter; LA: left atrium; LVEDV: left ventricular end-diastolic volume; LVESV: left ventricular end-systolic volume; LVIDd: left ventricular internal diameter end diastole; LVIDs: left ventricular internal diameter end systole; LVPWd: left ventricular posterior wall diameter; LVEF: left ventricular ejection fraction; MR: mitral valve regurgitation; RV: right ventricle; TR: tricuspid valve regurgitation.
Greater or equal to moderate TR	1.26 (0.78 - 1.49)	0.47
Greater or equal to moderate MR	1.12 (0.78 - 1.52)	0.32
Greater or equal to moderate RV systolic dysfunction	1.41 (1.12 - 1.73)	0.005

Table 2. Differences in Echocardiographic Adjusting for Demographics Using the Non-Methamphetamine-Associated Heart Failure as Reference

Variables

Mean differences (95% CI)

P-value

LVEF

5.37 (2.81 - 7.64)

< 0.001

LVIDd/BSA

0.11 (-0.03 - 0.26)

0.11

LVIDs/BSA

0.17 (0.01 - 0.33)

0.04

EDV/BSA

4.33 (-1.86 - 10.33)

0.17

ESV/BSA

4.33 (-0.74 - 9.39)

0.09

LA diameter

0.196 (-0.60 - 0.45)

0.13

E/A ratio

-0.95 (-0.32 - 0.13)

0.41

TR velocity

0.05 (-0.08 - 0.17)

0.44

Variables

Risk ratio (95% CI)

P-value

BSA: body surface area; CI: confidence interval; E/A: peak velocity blood flow from early diastole to peak velocity flow in late diastole caused by atrial contraction; IVSD: interventricular septal diameter; LA: left atrium; LVEDV: left ventricular end-diastolic volume; LVESV: left ventricular end-systolic volume; LVIDd: left ventricular internal diameter end diastole; LVIDs: left ventricular internal diameter end systole; LVPWd: left ventricular posterior wall diameter; LVEF: left ventricular ejection fraction; MR: mitral valve regurgitation; RV: right ventricle; TR: tricuspid valve regurgitation.

Greater or equal to moderate TR

1.26 (0.78 - 1.49)

0.47

Greater or equal to moderate MR

1.12 (0.78 - 1.52)

0.32

Greater or equal to moderate RV systolic dysfunction

1.41 (1.12 - 1.73)

0.005

**Table 3.** Univariate Outcomes and Outcomes With Propensity Score Matching
	MethHF (n = 101)	Non-MethHF (n = 1,554)	P-value
^aReference group. Values for the MethHF group use absolute (length of stay) and relative (30-day and 365-day endpoints) differences compared with the reference group. MethHF: methamphetamine-associated heart failure.
Univariate outcomes
Length of stay (days)	5.2 ± 6.6	7.1 ± 8.8	< 0.01
30-day combined	18 (17.8%)	413 (26.6%)	0.03
65-day mortality	18 (17.8%)	472 (30.4%)	< 0.01
Propensity score matching using non-MethHF as reference (full model)
Length of stay (days)	6.0 (4.4 - 7.6)	7.1^a	0.18
30-day combined	19.9% (12.8-31.4%)	26.6%^a	0.22
365-day mortality	28.3% (18.5-43.5%)	30.4%^a	0.74
Propensity score matching using non-MethHF as reference (reduced model)
Length of stay (days)	5.8 (4.3 - 7.4)	7.1^a	0.12
30-day combined	18.9% (12.0-29.8%)	26.6%^a	0.14
365-day mortality	27.1% (17.6-42.6%)	30.4%^a	0.63

Table 3. Univariate Outcomes and Outcomes With Propensity Score Matching

MethHF (n = 101)

Non-MethHF (n = 1,554)

P-value

^aReference group. Values for the MethHF group use absolute (length of stay) and relative (30-day and 365-day endpoints) differences compared with the reference group. MethHF: methamphetamine-associated heart failure.

Univariate outcomes

Length of stay (days)

5.2 ± 6.6

7.1 ± 8.8

< 0.01

30-day combined

18 (17.8%)

413 (26.6%)

0.03

65-day mortality

18 (17.8%)

472 (30.4%)

< 0.01

Propensity score matching using non-MethHF as reference (full model)

Length of stay (days)

6.0 (4.4 - 7.6)

7.1^a

0.18

30-day combined

19.9% (12.8-31.4%)

26.6%^a

0.22

365-day mortality

28.3% (18.5-43.5%)

30.4%^a

0.74

Propensity score matching using non-MethHF as reference (reduced model)

Length of stay (days)

5.8 (4.3 - 7.4)

7.1^a

0.12

30-day combined

18.9% (12.0-29.8%)

26.6%^a

0.14

365-day mortality

27.1% (17.6-42.6%)

30.4%^a

0.63

**Table 4.** Binary Logistic Regression for 30-Day Combined Outcome and 365-Day Mortality of MethHF Group (n = 101)
Variables	30-day combined outcome	365-day mortality
BSA: body surface area; CI: confidence interval; E/A: peak velocity blood flow from early diastole to peak velocity flow in late diastole caused by atrial contraction; IVSD: interventricular septal diameter; LA: left atrium; LVEDV: left ventricular end-diastolic volume; LVESV: left ventricular end-systolic volume; LVIDd: left ventricular internal diameter end diastole; LVIDs: left ventricular internal diameter end systole; LVPWd: left ventricular posterior wall diameter; LVEF: left ventricular ejection fraction; MethHF: methamphetamine-associated heart failure; MR: mitral valve regurgitation; Na: sodium; SBP: systolic blood pressure; OR: odds ratio; RV: right ventricle; TR: tricuspid valve regurgitation.
LVEF (%)	1.01 (0.97 - 1.05)	0.68	0.99 (0.95 - 1.03)	0.72
LVIDd/BSA (cm/m²)	1.49 (0.64 - 3.44)	0.36	1.61 (0.71 - 3.68)	0.26
LVIDs/BSA (cm/m²)	1.38 (0.61 - 3.14)	0.44	1.27 (0.57 - 2.8)	0.56
EDV/BSA (mL/m²)	1.00 (0.98 - 1.02)	0.69	1.01 (0.99 - 1.03)	0.20
ESV/BSA (mL/m²)	1.00 (0.98 - 1.03)	0.70	1.01 (0.98 - 1.03)	0.39
LA diameter (cm)	1.37 (0.72 - 2.63)	0.34	0.73 (0.39 - 1.36)	0.32
E/A ratio	1.63 (0.76 - 3.50)	0.21	1.31 (0.59 - 2.9)	0.50
TR velocity (m/s)	1.13 (0.42 - 3.06)	0.81	1.18 (0.46 - 3.04)	0.73
Greater or equal to moderate TR	4.67 (1.5 - 14.50)	< 0.01	4.67 (1.5 - 14.50)	< 0.01
Greater or equal to moderate MR	2.67 (0.89 - 8.01)	0.08	1.96 (0.66 - 5.82)	0.23
Greater or equal to moderate RV systolic dysfunction	1.56 (0.51 - 4.76)	0.44	1.12 (0.36 - 3.48)	0.85

Table 4. Binary Logistic Regression for 30-Day Combined Outcome and 365-Day Mortality of MethHF Group (n = 101)

Variables

30-day combined outcome

365-day mortality

OR (95% CI)

P-value

OR (95% CI)

p-value

BSA: body surface area; CI: confidence interval; E/A: peak velocity blood flow from early diastole to peak velocity flow in late diastole caused by atrial contraction; IVSD: interventricular septal diameter; LA: left atrium; LVEDV: left ventricular end-diastolic volume; LVESV: left ventricular end-systolic volume; LVIDd: left ventricular internal diameter end diastole; LVIDs: left ventricular internal diameter end systole; LVPWd: left ventricular posterior wall diameter; LVEF: left ventricular ejection fraction; MethHF: methamphetamine-associated heart failure; MR: mitral valve regurgitation; Na: sodium; SBP: systolic blood pressure; OR: odds ratio; RV: right ventricle; TR: tricuspid valve regurgitation.

LVEF (%)

1.01 (0.97 - 1.05)

0.68

0.99 (0.95 - 1.03)

0.72

LVIDd/BSA (cm/m²)

1.49 (0.64 - 3.44)

0.36

1.61 (0.71 - 3.68)

0.26

LVIDs/BSA (cm/m²)

1.38 (0.61 - 3.14)

0.44

1.27 (0.57 - 2.8)

0.56

EDV/BSA (mL/m²)

1.00 (0.98 - 1.02)

0.69

1.01 (0.99 - 1.03)

0.20

ESV/BSA (mL/m²)

1.00 (0.98 - 1.03)

0.70

1.01 (0.98 - 1.03)

0.39

LA diameter (cm)

1.37 (0.72 - 2.63)

0.34

0.73 (0.39 - 1.36)

0.32

E/A ratio

1.63 (0.76 - 3.50)

0.21

1.31 (0.59 - 2.9)

0.50

TR velocity (m/s)

1.13 (0.42 - 3.06)

0.81

1.18 (0.46 - 3.04)

0.73

Greater or equal to moderate TR

4.67 (1.5 - 14.50)

< 0.01

4.67 (1.5 - 14.50)

< 0.01

Greater or equal to moderate MR

2.67 (0.89 - 8.01)

0.08

1.96 (0.66 - 5.82)

0.23

Greater or equal to moderate RV systolic dysfunction

1.56 (0.51 - 4.76)

0.44

1.12 (0.36 - 3.48)

0.85