Comparison of Functional and Hemodynamic Parameters Between Methamphetamine-Associated and Idiopathic Pulmonary...

Background: We conducted a systematic review and meta-analysis to compare functional and hemodynamic parameters between patients with Meth-APAH and idiopathic PAH (IPAH). Methods: MEDLINE, Scopus, and gray literature were searched up to September 2025. Eligible studies were observational and compared functional and hemodynamic parameters between patients with Meth-APAH and IPAH. All participants had undergone diagnostic right heart catheterization (RHC) and were classified by methamphetamine use history and/or toxicological screening. Primary outcomes included World Health Organization Functional Class III or IV (WHO-FC III/IV), six-minute walk distance (6-MWD), and mean pulmonary arterial pressure (mPAP). Secondary outcomes were cardiac index (CI), right atrial pressure (RAP), pulmonary vascular resistance (PVR), stroke volume index (SVI), pulmonary artery wedge pressure (PAWP), and heart rate (HR). Random-effects models were applied for pooled estimates. Results: Five studies comprising 1991 participants were included. Patients with Meth-APAH demonstrated a significantly higher risk of being classified as WHO-FC III/IV (RR 1.17, 95%CI 1.05-1.30, p = 0.01), as well as higher RAP (MD 1.59, 95%CI 0.07-3.11, p = 0.04) and reduced SVI (MD -3.57, 95%CI -6.74--0.4, p = 0.04), but differences were modest. No significant differences were found for 6-MWD, mPAP, CI, PVR, PAWP, or HR. Conclusions: Meth-APAH could be associated with worse functional and hemodynamic profile compared to IPAH, but available studies are few with high heterogeneity, so that clear differences in several functional and hemodynamic parameters could not be established between these disease entities. These results highlight the need for further research in this direction.