Heavy Burden of Toxic Dilated Cardiomyopathy Among Young Adults: A Retrospective Study and Review of the Literature

Dilated 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 ye...

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Published in:	Canadian journal of cardiology 2022-01, Vol.38 (1), p.49-58
Main Authors:	Cinq-Mars, Alexandre, Massot, Montse, Belzile, David, Turgeon, Pierre Yves, Dubois-Sénéchal, Sacha-Michelle, Laliberté, Claudine, Komlosy, Marie-Ève, Leblanc, Marie-Hélène, Bergeron, Sébastien, O’Connor, Kim, Morin, Joëlle, Bourgault, Christine, Bernier, Mathieu, Beaudoin, Jonathan, Radermaker, Steve, Laflamme, Maxime, Charbonneau, Eric, Sénéchal, Mario
Format:	Article
Language:	eng
Subjects:	Cardiomyopathy, Dilated - chemically induced Cardiomyopathy, Dilated - therapy Heart-Assist Devices Humans Retrospective Studies Substance-Related Disorders - complications Ventricular Function, Left - drug effects Ventricular Function, Left - physiology Ventricular Remodeling - drug effects Young Adult
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Summary:	Dilated 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. This 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. A 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. TCM 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. La cardiomyopathie dilatée (CMD) est une entité bien décrite de l'insuffisance cardiaque (IC) avec fraction d'éjection du ventricule gauche (FEVG) réduite. Récemment, les drogues et autres substances ont été reconnues comme des déclencheurs potentiels de la CMD. L'objectif de cette étude était d'évaluer la survie chez les patients ≤ 65 ans atteints de cardiomyopathie toxique (CMT). Le remodelage ventriculaire gauche et l'utilité potentielle des dispositifs d'assistance ventriculaire gauche (DAVG) ont également été évalués. Il s'agissait d'une étude rétrospective monocentrique de janvier 2003 à août 2019 portant sur 553 patients ≤ 65 ans avec une FEVG < 40 % dans un centre de cardiologie de soins tertiaires. Au total, 201 patients (36 %) ont reçu un diagnostic de DCM idiopathique. Une analyse plus poussée a permis d'identifier 38 patients (19 %) pour lesquels une CMT était l'étiologie la plus probable (a
ISSN:	0828-282X 1916-7075