Cardiomyopathy in patients with acute ischemic stroke and methamphetamine use: Relevance for cardioembolic stroke and outcome

Abstract

ABSTRACTMethamphetamine use has emerged as a major risk factor of cardiovascular and cerebrovascular disease in young adults. The aim of this study was to investigate the relevance of methamphetamine use and cardiomyopathy in patients with acute ischemic stroke.We performed a retrospective study of consecutive patients with acute ischemic stroke admitted at our medical center between 2019 and 2022. All patients were screened for methamphetamine use and cardiomyopathy defined as left ventricular ejection fraction ≤ 45%. Methamphetamine use was identified by self-reported history of use and/or positive urine drug screen. Logistic regression model was performed to analyze the relevance of methamphetamine-associated cardiomyopathy and cardioembolic stroke.Among 973 consecutive patients screened for the study, 48 (4.9%) were identified to have methamphetamine use. Compared with Non-meth group (n=892), the patients in the Meth group were significantly younger (53.2 ± 10.0 vs. 69.7 ± 15.2, p <0.001), more likely male (76.6% vs. 50.0%, p <0.001), and associated with significantly higher rate of cardiomyopathy (30.4% vs. 14.0%, p <0.01). They were also less likely to have history of atrial fibrillation (8.7% vs. 33.4%, p<0.01) or hyperlipidemia (28.3% vs. 51.7%, p <0.01). Compared with patients with cardiomyopathy without methamphetamine use, those with methamphetamine use and cardiomyopathy had better functional outcome at 3 months, likely due to younger age and fewer comorbidities. In the logistic regression model, methamphetamine-associated cardiomyopathy was found to be a significant risk factor of cardioembolic stroke (OR 2.88, 95% CI 1.81-4.58, p < 0.0001).Our results demonstrate that methamphetamine use increases the risk of cardiomyopathy and cardioembolic stroke in young adults.