Cardiovascular magnetic resonance imaging (CMR) “saw” myocardial damage that usually was not apparent on troponin or natriuretic-peptide assays or by electrocardiography, echocardiography, or stress testing in most of a group of asymptomatic chronic cocaine abusers, according to a report published online June 20, 2011 in the journal Heart .
Subclinical cardiac structural damage is common in long-term cocaine addicts, at least as assessed by CMR, and seems to precede onset of the more recognized clinical forms of cocaine-related heart disease, according to the authors, led by Dr Giovanni Donato Aquaro (Fondazione G Monasterio Regione Toscanad CNR, Pisa, Italy). “This may indicate the need for screening in long-term users, even when they are asymptomatic,” state the authors.
Of 25 men and five women who had no symptoms or history of heart disease—but a long history of cocaine addiction—and were evaluated with CMR and the other tests at least 48 hours after drug withdrawal as part of a rehabilitation program, 83% showed CMR evidence of myocardial edema or fibrosis, report the authors.
Yet only minimal resting ECG abnormalities were observed, and they were limited to 15 patients. Twelve patients showed regional wall-motion abnormalities at echocardiography, but the entire cohort had normal global LV function. There were no arrhythmias, angina, or other evidence of ischemia at stress testing or 24-hour Holter monitoring. One patient had slightly elevated troponin I, but all other biomarker tests in the entire group were negative.
In CMR performed on a 1.5-tesla scanner, left ventricular edema was observed in 47% of patients and fibrosis (with gadolinium enhancement) in 73%. Of the 22 patients with fibrosis by CMR, seven showed an ischemic and 15 a nonischemic pattern of myocardial damage. Eleven patients showed both edema and fibrosis, usually in the same ventricular segment.
The likelihood of myocardial edema was proportional to the degree of cocaine use as determined by self-reported intake and urinary assays for cocaine and its metabolites prior to CMR imaging, “thus suggesting a toxic, dose-related effect.”
Source: theheart.org