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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 31, No 5, September/October 2020
AFRICA
241
Effect of heroin on right ventricular cardiac performance
Murat Selcuk, Ersin Yildirim, Faysal Saylik, Ozgur Deniz, Ferit Onur Mutluer
Abstract
Objective:
The aim of this study was to investigate the effects
of heroin addiction, which is an important social and health
problem, on right cardiac function.
Methods:
A total of 85 individuals were included in the
study. The study group comprised 45 patients smoking
heroin and the control group was 40 healthy individuals with
no drug addiction. Patients injecting heroin were excluded.
Echocardiographic evaluation of patients using heroin was
performed and compared with those in the control group.
Results:
The right ventricle and pulmonary artery diameters
in the heroin group were found to be higher compared to the
control group. The myocardial performance index (MPI) was
higher and more abnormal in the heroin group (0.48
±
0.22 vs
0.39
±
0.11,
p
< 0.05) whereas isovolumic acceleration (IVA)
of the right ventricle was significantly lower in the heroin
group (2.92
±
0.69 vs 3.4
±
0.68 m/s
2
,
p
< 0.01). No significant
difference was observed between the groups with regard to the
right ventricular ejection fraction (RVEF) (59.6
±
2.5 vs 60.6
±
2.3%,
p
= 0.08), tricuspid annular plain systolic excursion
(TAPSE) (24.1
±
4.2 vs 24.5
±
2.4 mm,
p
= 0.7), tissue Doppler
imaging S wave (TDI-S) (13.7
±
2.1 vs 13.8
±
2.1 cm/s,
p
=
0.86) and right ventricular fractional area change (RVFAC)
(42.7
±
8.3 vs 43.9
±
3.5%,
p
= 0.4). Multivariate and univari-
ate regression analyses revealed independent correlation
between the pulmonary artery diameter and RVIVA, and
heroin addiction.
Conclusion:
Heroin addiction negatively affected right ventric-
ular function and more attention should be paid to the
cardiac function of these patients.
Keywords:
heroin, right ventricular function, myocardial perfor-
mance index
Submitted 17/11/19, accepted 27/1/20
Published online 5/3/20
Cardiovasc J Afr
2020;
31
: 241–244
www.cvja.co.zaDOI: 10.5830/CVJA-2020-002
Heroin addiction is one of the most destructive and expensive
public health problems. Heroin, which is a central nervous
system depressant (diacetylmorphine), is a semi-synthetic opiate.
Mortality rate among heroin users varies between 1 and 3%,
and the most effective treatment method for heroin addiction
is opioid replacement therapy.
1,2
Heroin is commonly smoked,
snorted and injected intravenously.
A common negative effect of heroin addiction is respiratory
depression, which may lead to death, especially following
intravenous (IV) injection. Additionally, heroin-related
pulmonary oedema has been reported in previous studies.
3
IV use of the drug is difficult to evaluate since the injection is
generally performed together with other chemical substances
named adulterants.
4
Heroin addiction is a serious social health problem. We
evaluated patients who smoked heroin and aimed to investigate
its effect on right heart function since not much is known about
the cardiac effect of heroin addiction.
Methods
Informed consent was obtained from all patients and they signed
a consent form to participate in the study. The Van Education
and Research Hospital ethics committee approved the study.
A total of 85 individuals were included in the study. The study
group comprised 45 patients smoking heroin and undergoing
therapy in the Alcohol and Drug Addiction Treatment and
Training Centre of the Van Training and Research Hospital
between 2014 and 2016. The control group consisted of 40
healthy individuals with no drug addiction other than smoking
cigarettes.
Subjects who used heroin via the IV route, alcoholics, those
with coronary artery disease, cardiac failure, cardiac valve
disorders, known arrhythmias, hypertension, congenital cardiac
diseases, diabetes, hepatic or renal failure, chronic obstructive
pulmonary disease, endocrine diseases, metabolic or electrolyte
disorders, acute or chronic infections or those on medications
due to any type of disease, were excluded from the study.
The clinical and demographic characteristics of the patients,
and status and duration of heroin addiction were obtained from
the patients and patient files in the hospital. Body mass index,
defined as body mass divided by the square of the height, was
determined. Electrocardiography (ECG) records of the patients
were obtained via the Schiller Cardiovit AT-102 plus using the
standard 12 derivation (10 mm/mV calibration and 25 mm/s
sliding rate). Complete blood counts and biochemical tests were
performed using a Beckman Coulter LH-750 and Beckman
Coulter L × 20, respectively, and the results of each patient were
recorded.
Echocardiographic evaluations of the patients were performed
at the time of admission to our hospital while the patients were
still under the influence of heroin.
All participants underwent
two-dimensional (2D) andDoppler echocardiographic evaluation
(VIVID 3, General Electric, USA). 2D echocardiographic
Department of Cardiology, Van Education and Research
Hospital, University of Health Sciences, Van, Turkey
Murat Selcuk, MD,
Faysal Saylik,MD
Ferit Onur Mutluer, MD
Department of Cardiology, Istanbul Umraniye Education
and Research Hospital, University of Health Sciences,
Istanbul, Turkey
Ersin Yildirim, MD,
ersinyil44@gmail.comDepartment of Psychiatry, Van Education and Research
Hospital, University of Health Sciences, Van, Turkey
Ozgur Deniz, MD