Patients with Methamphetamine-Associated Pulmonary Arterial Hypertension Have Less Favorable Hemodynamics Than Other Patients with Group 1 PAH

Purpose Methamphetamine-Associated Pulmonary Arterial Hypertension (Meth-APAH) is recognized as a definite cause of PAH. Given that methamphetamine use induces both myocardial dysfunction and pulmonary vascular remodeling, we sought to assess differences in echocardiographic and hemodynamic parameters between patients with Meth-APAH and other patients with Group 1 PAH. Methods We performed a retrospective single-center cohort study of patients with Group 1 PAH in whom the first right heart catheterization (RHC) was performed within two months of a transthoracic echocardiogram (TTE). We extracted demographics and clinical data from the electronic medical record, including diagnostic etiology of PAH determined by the treating physician. TTE and RHC parameters were analyzed using Student's t-test and the Chi-Square test. We assessed time to first hospitalization and to death using Cox-proportional hazards modeling, adjusted for age, gender, and race. Results Of 302 patients, 57 had Meth-APAH. Patients with Meth-APAH were older (53 vs 49 years, p=0.05), more likely to be male (47% vs 39%, p=0.03), white (64.5% vs 46.7%, p=0.03), and to have a history of smoking (61% vs 35%, p Conclusion Patients with Meth-APAH are a unique subset of Group 1 PAH, with less favorable hemodynamics than other diagnostic etiologies and evidence of greater right ventricular dysfunction. Better understanding of how methamphetamine use causes myocardial dysfunction is necessary to understand the pathogenesis of Meth-APAH.