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Ultrasonic Assessment of Myocardial Microstructure
Published on: January 14, 2014
Methylenedioxymethamphetamine (ecstasy)-related myocardial hypertrophy: an autopsy study
Manish M Patel1, Martin G Belson, David Wright
1Georgia Poison Control System, 3661 Briarcliff, Atlanta, GA 30322, USA; Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GA 30333, USA. mmpatel@emory.edu
Background:
Myocardial hypertrophy is a well-recognized complication of cocaine and methamphetamine abuse and is a strong, independent risk factor for sudden death, myocardial infarction, and congestive heart failure. We sought to determine if use of MDMA (methylenedioxyamphetamine or "ecstasy") is associated with myocardial hypertrophy at death.
Methods And Results:
A matched, retrospective study using medical examiner (ME) death reports. Consecutive MDMA positive (+) and MDMA negative (-) deaths identified from MEs in 10 states and a local county, respectively. Five MDMA(-) cases were matched to each MDMA(+) case for age, sex, and ethnicity. MDMA(+) cases were confirmed using GC/MS and other drugs of abuse (e.g., cocaine and methamphetamine) were absent. Matched MDMA(-) cases were trauma fatalities with intact hearts and blood negative for all illicit stimulants. Cardiac weights were compared between the two groups. Twenty seven MDMA(+) deaths and 135 matched MDMA(-) deaths were enrolled. Mean age was 20 years (range 16--33 years); 44% were female. 70.4% were Caucasian, 14.8% African-American, 11.1% Asian, and 3.7% Hispanic. Mean heart weight of MDMA(+) fatalities was 315.7 and 277.2g for MDMA(-) fatalities (Diff=38.5 g; 95% CI=18.3--8.7). Multivariate analysis revealed that MDMA(+) fatalities were more likely to have an enlarged heart (OR=18.3; 95% CI=3.6--1.6).
Conclusion:
The findings of this study suggest that MDMA users might also be at risk for myocardial hypertrophy and possible cardiac toxicity, similar to other stimulants.
Insights
Methylenedioxymethamphetamine (MDMA) use is linked to myocardial hypertrophy, an enlarged heart. This finding suggests MDMA may pose cardiac risks similar to other stimulants, increasing the risk of sudden cardiac events.
Area of Science:
- Cardiology
- Toxicology
- Forensic Pathology
Background:
- Myocardial hypertrophy is a known risk of stimulant abuse, increasing sudden death risk.
- Cocaine and methamphetamine use are established causes of cardiac complications.
- The cardiac effects of methylenedioxymethamphetamine (MDMA) remain less understood.
Purpose of the Study:
- To investigate the association between methylenedioxymethamphetamine (MDMA) use and myocardial hypertrophy.
- To determine if MDMA is linked to cardiac enlargement at the time of death.
- To compare cardiac pathology in MDMA users versus non-users.
Main Methods:
- A retrospective, matched case-control study using medical examiner data.
- MDMA-positive fatalities were matched with MDMA-negative trauma fatalities.
- Cardiac weights were analyzed, controlling for other stimulant use.
Main Results:
- MDMA-positive fatalities had significantly higher mean heart weights (315.7g vs. 277.2g).
- MDMA use was independently associated with an enlarged heart (Odds Ratio=18.3).
- Cases were confirmed negative for cocaine and methamphetamine.
Conclusions:
- MDMA use is associated with myocardial hypertrophy.
- MDMA may induce cardiac toxicity similar to other stimulant drugs.
- Individuals using MDMA may be at increased risk for cardiac events.
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