Emily O'Neill, Dai-Yin Lu, Satvik Ramakrishna, Dominique Ingram, Benjamin Kogelschatz, John J. Ryan, Jennalyn Mayeux, Christy Ma, Dana Klanderud, Emily Beck, Elizabeth Dranow, Nathan Hatton, Katharine Clapham
{"title":"与特发性肺动脉高压相比，甲基苯丙胺相关性肺动脉高压与更差的右心室功能相关：一项匹配研究","authors":"Emily O'Neill, Dai-Yin Lu, Satvik Ramakrishna, Dominique Ingram, Benjamin Kogelschatz, John J. Ryan, Jennalyn Mayeux, Christy Ma, Dana Klanderud, Emily Beck, Elizabeth Dranow, Nathan Hatton, Katharine Clapham","doi":"10.1111/echo.70180","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Background</h3>\n \n <p>Methamphetamine is increasingly recognized as a cause of pulmonary arterial hypertension (PAH). This study examines whether non-invasively measured metrics of right heart function, right atrial (RA) and right ventricular (RV) strain, are more impaired in methamphetamine-associated PAH (MA-PAH) compared with idiopathic PAH (IPAH).</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>A retrospective cohort analysis of 51 patients with MA-PAH matched for mean pulmonary artery pressure (mPAP) with 51 patients with IPAH followed at the pulmonary hypertension clinic at the University of Utah was performed. Invasive hemodynamics and echocardiographic measures of right heart function, including RA strain and RV free wall strain, were compared.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Compared to the matched IPAH group, MA-PAH patients had lower cardiac index (2.04 ± 0.84 vs. 2.52 ± 1.07 L/min/m<sup>2</sup>, <i>p</i> = 0.016) and higher pulmonary vascular resistance (PVR; 11.8 ± 6.8 vs. 8.9 ± 4.8 Wood units, <i>p</i> = 0.018). The MA-PAH group had larger RA maximal and minimal volume, lower RA reservoir strain (26.4 ± 11.7 vs. 33.4 ± 14.8 %, <i>p</i> = 0.011), more significant RV chamber dilation, and lower fractional area change (FAC; 21.1 ± 11.1 % vs. 34.5 ± 11.8 %, <i>p</i> < 0.001), compared to the IPAH group. RV e’ was lower in MA-PAH (6.5 ± 2.8 cm/s vs. 8.3 ± 4.3 cm/s, <i>p</i> = 0.021), suggesting worse RV diastolic function and RV free wall strain was significantly more reduced compared to patients with I-PAH (17.0 ± 6.5 vs. 22.3 ± 7.2 %, <i>p</i> < 0.001). There were no differences in 5-year survival (<i>p</i> = 0.26), 6MW distance including stratification for males and females (<i>p</i> = 0.249 in females, <i>p</i> = 0.279 in males), and rehospitalization rates within 5 years of diagnosis (<i>p</i> = 0.70).</p>\n </section>\n \n <section>\n \n <h3> Discussion</h3>\n \n <p>Despite a similar mPAP, patients with MA-PAH had more RA dilation, RV dilation, lower RV systolic/diastolic function, and worse RA and RV mechanics as assessed by strain compared to patients with I-PAH. Our findings suggest that, in addition to causing remodeling of the pulmonary vasculature, methamphetamine may have a direct cardiotoxic effect on the right heart.</p>\n </section>\n </div>","PeriodicalId":50558,"journal":{"name":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","volume":"42 5","pages":""},"PeriodicalIF":1.6000,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/echo.70180","citationCount":"0","resultStr":"{\"title\":\"Methamphetamine-Associated Pulmonary Arterial Hypertension Is Associated With Worse Right Ventricular Function Than Idiopathic Pulmonary Arterial Hypertension: A Matched Study\",\"authors\":\"Emily O'Neill, Dai-Yin Lu, Satvik Ramakrishna, Dominique Ingram, Benjamin Kogelschatz, John J. 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Invasive hemodynamics and echocardiographic measures of right heart function, including RA strain and RV free wall strain, were compared.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Compared to the matched IPAH group, MA-PAH patients had lower cardiac index (2.04 ± 0.84 vs. 2.52 ± 1.07 L/min/m<sup>2</sup>, <i>p</i> = 0.016) and higher pulmonary vascular resistance (PVR; 11.8 ± 6.8 vs. 8.9 ± 4.8 Wood units, <i>p</i> = 0.018). The MA-PAH group had larger RA maximal and minimal volume, lower RA reservoir strain (26.4 ± 11.7 vs. 33.4 ± 14.8 %, <i>p</i> = 0.011), more significant RV chamber dilation, and lower fractional area change (FAC; 21.1 ± 11.1 % vs. 34.5 ± 11.8 %, <i>p</i> < 0.001), compared to the IPAH group. RV e’ was lower in MA-PAH (6.5 ± 2.8 cm/s vs. 8.3 ± 4.3 cm/s, <i>p</i> = 0.021), suggesting worse RV diastolic function and RV free wall strain was significantly more reduced compared to patients with I-PAH (17.0 ± 6.5 vs. 22.3 ± 7.2 %, <i>p</i> < 0.001). There were no differences in 5-year survival (<i>p</i> = 0.26), 6MW distance including stratification for males and females (<i>p</i> = 0.249 in females, <i>p</i> = 0.279 in males), and rehospitalization rates within 5 years of diagnosis (<i>p</i> = 0.70).</p>\\n </section>\\n \\n <section>\\n \\n <h3> Discussion</h3>\\n \\n <p>Despite a similar mPAP, patients with MA-PAH had more RA dilation, RV dilation, lower RV systolic/diastolic function, and worse RA and RV mechanics as assessed by strain compared to patients with I-PAH. Our findings suggest that, in addition to causing remodeling of the pulmonary vasculature, methamphetamine may have a direct cardiotoxic effect on the right heart.</p>\\n </section>\\n </div>\",\"PeriodicalId\":50558,\"journal\":{\"name\":\"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques\",\"volume\":\"42 5\",\"pages\":\"\"},\"PeriodicalIF\":1.6000,\"publicationDate\":\"2025-05-05\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://onlinelibrary.wiley.com/doi/epdf/10.1111/echo.70180\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1111/echo.70180\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Echocardiography-A Journal of Cardiovascular Ultrasound and Allied Techniques","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1111/echo.70180","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
甲基苯丙胺越来越被认为是肺动脉高压（PAH）的原因之一。本研究探讨了与特发性PAH （IPAH）相比，甲基苯丙胺相关PAH （MA-PAH）是否更容易损害非侵入性测量的右心功能指标，右心房（RA）和右心室（RV）张力。方法回顾性队列分析51例平均肺动脉压（mPAP）匹配的MA-PAH患者和51例IPAH患者在犹他大学肺动脉高压门诊随访。比较有创血流动力学和超声心动图测量右心功能，包括RA应变和右心室无壁应变。结果与匹配的IPAH组相比，MA-PAH患者心脏指数（2.04±0.84∶2.52±1.07 L/min/m2, p = 0.016）较低，肺血管阻力(PVR；11.8±6.8比8.9±4.8木单位，p = 0.018)。MA-PAH组RA最大和最小体积更大，RA库应变更低（26.4±11.7% vs. 33.4±14.8%,p = 0.011）， RV室扩张更显著，分数面积变化更低(FAC；21.1±11.1% vs. 34.5±11.8%,p <；0.001)，与IPAH组相比。MA-PAH组RV e′较低（6.5±2.8 cm/s vs. 8.3±4.3 cm/s, p = 0.021），表明与I-PAH组相比，RV舒张功能较差，RV游离壁应变明显降低(17.0±6.5 vs. 22.3%±7.2%,p <；0.001)。5年生存率（p = 0.26）、包括分层的男女6MW距离（女性p = 0.249，男性p = 0.279）、诊断后5年内再住院率（p = 0.70）均无差异。尽管mPAP相似，但与I-PAH患者相比，MA-PAH患者有更多的RA扩张，RV扩张，更低的RV收缩/舒张功能，以及更差的RA和RV力学。我们的研究结果表明，除了引起肺血管重塑外，甲基苯丙胺可能对右心脏有直接的心脏毒性作用。
Methamphetamine-Associated Pulmonary Arterial Hypertension Is Associated With Worse Right Ventricular Function Than Idiopathic Pulmonary Arterial Hypertension: A Matched Study
Background
Methamphetamine is increasingly recognized as a cause of pulmonary arterial hypertension (PAH). This study examines whether non-invasively measured metrics of right heart function, right atrial (RA) and right ventricular (RV) strain, are more impaired in methamphetamine-associated PAH (MA-PAH) compared with idiopathic PAH (IPAH).
Methods
A retrospective cohort analysis of 51 patients with MA-PAH matched for mean pulmonary artery pressure (mPAP) with 51 patients with IPAH followed at the pulmonary hypertension clinic at the University of Utah was performed. Invasive hemodynamics and echocardiographic measures of right heart function, including RA strain and RV free wall strain, were compared.
Results
Compared to the matched IPAH group, MA-PAH patients had lower cardiac index (2.04 ± 0.84 vs. 2.52 ± 1.07 L/min/m2, p = 0.016) and higher pulmonary vascular resistance (PVR; 11.8 ± 6.8 vs. 8.9 ± 4.8 Wood units, p = 0.018). The MA-PAH group had larger RA maximal and minimal volume, lower RA reservoir strain (26.4 ± 11.7 vs. 33.4 ± 14.8 %, p = 0.011), more significant RV chamber dilation, and lower fractional area change (FAC; 21.1 ± 11.1 % vs. 34.5 ± 11.8 %, p < 0.001), compared to the IPAH group. RV e’ was lower in MA-PAH (6.5 ± 2.8 cm/s vs. 8.3 ± 4.3 cm/s, p = 0.021), suggesting worse RV diastolic function and RV free wall strain was significantly more reduced compared to patients with I-PAH (17.0 ± 6.5 vs. 22.3 ± 7.2 %, p < 0.001). There were no differences in 5-year survival (p = 0.26), 6MW distance including stratification for males and females (p = 0.249 in females, p = 0.279 in males), and rehospitalization rates within 5 years of diagnosis (p = 0.70).
Discussion
Despite a similar mPAP, patients with MA-PAH had more RA dilation, RV dilation, lower RV systolic/diastolic function, and worse RA and RV mechanics as assessed by strain compared to patients with I-PAH. Our findings suggest that, in addition to causing remodeling of the pulmonary vasculature, methamphetamine may have a direct cardiotoxic effect on the right heart.
期刊介绍：
Echocardiography: A Journal of Cardiovascular Ultrasound and Allied Techniques is the official publication of the International Society of Cardiovascular Ultrasound. Widely recognized for its comprehensive peer-reviewed articles, case studies, original research, and reviews by international authors. Echocardiography keeps its readership of echocardiographers, ultrasound specialists, and cardiologists well informed of the latest developments in the field.
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