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Clinical Differences between Methamphetamine and Non-Methamphetamine Associated Non-Ischemic Dilated Cardiomyopathy
S62 Journal of Cardiac Failure Vol. 25 No. 8S August 2019 should be closely observed during the first few weeks after initiation of treatment. Additional studies with larger samples are needed to validate these findings.
disease were followed for a median of 8 years. Patients were at low risk based on PEACE score and NTproBNP [median 46 (IQR 21-91)pg/mL]. Proportion of patients with PEACE risk score at average (n=227, 12.5%) or high risk (n=10, 0.6%) increased over time, which correlated with the increase in overall NT-proBNP levels over time (Figure, p<0.01). Interestingly, a subset of patients (n=196, 10%) at low risk by PEACE risk score had NTproBNP levels above 125 pg/mL despite eGFR >60. Conclusions: Proportion of patients at average and high risk for HF increase with time which correlated with NTproBNP levels. Mismatch between PEACE HF risk and NTproBNP was seen among low risk patients warranting further investigation.
162 Sacubitril-Valsartan Initiation Post-Left Ventricular Assist Device is Safe and Effective Varinder K. Randhawa, Lucianne West, Jacob Luthman, Jerry Estep, Edward G. Soltesz, Randall C. Starling; Cleveland Clinic Foundation, Cleveland, OH Introduction and Aim: Guideline-directed medical therapy for heart failure (HF) with reduced ejection fraction includes demonstrated benefit from the combination drug sacubitril-valsartan in acute and chronic heart failure. However, little is known of its’ tolerability in patients with stage D HF requiring durable left ventricular assist device (LVAD) implantation. Our aim was to determine its’ safety and efficacy in patients with durable LVADs. Methods: We retrospectively reviewed patients who were initiated on sacubitril-valsartan post-LVAD implantation at our institution for baseline characteristics and drug tolerability. Results: We identified 10 patients with a mean age of 57.5 § 8.7 years who were initiated on sacubitril-valsartan post-LVAD implantation, 80% for destination therapy. Of these, 4 had axial and 6 had centrifugal flow pumps. The majority were Caucasian (60%) and male (70%). The initiation of sacubitril-valsartan reduced MAP by 20.0 § 14.0 mmHg (p=0.002), and NT-proBNP from 2,929 pg/mL to 1,530 pg/mL (p=0.36). By contrast, mean serum creatinine and potassium were unaltered (Table 1). Only one patient experienced hyperkalemia, and no patients developed drug-related acute kidney injury (decline in eGFR >25%), hypotension or angioedema. Following the initiation of sacubitril-valsartan, there was a concomitant reduction in the use of other oral vasodilators (30-50%), mineralocorticoid receptor antagonists (20%), and non-potassium sparing diuretics (10%). Conclusions: Sacubitril-valsartan initiation in patients after LVAD implantation is tolerated, and reduces MAP. Elevated MAP has been related to adverse events post-LVAD and sacubitril-valsartan appears safe and effective in our preliminary experience in patients supported with continuous flow LVAD. Table 1. Table 1. Impact of Sacubitril-Valsartan on Clinical Variables.
Clinical Variable MAP (mm Hg) Potassium (mM) Creatinine (mg/dL) NT-proBNP (pg/mL)
Prior to SacubitrilValsartan Initiation
After SacubitrilValsartan Initiation
Delta Change With SacubitrilValsartan
P-value
98.8 § 12.2 4.14 § 0.66 1.28 § 0.26 2,929.5 § 5,013.26
78.4 § 12.1 4.34 § 0.36 1.39 § 0.26 1,530.0 § 1,676.34
(-) 20.0 § 14.0 (+) 0.11 § 0.44 (+) 0.08 § 0.17 (-) 1,631 § 5,194.18
p=0.002 p=0.46 p=0.21 p=0.36
163 Temporal Change in PEACE Heart Failure Risk Score and Association with Natriuretic Peptides in the MESA Population Abhinav Sood, Wilson W.H. Tang; Cleveland Clinic, Cleveland, OH Introduction: We assessed temporal evolution of the PEACE score, a validated heart failure (HF) prediction score, in the MESA population and its correlation with NTproBNP Hypothesis: PEACE risk score will increase with time and have a positive correlation with NTproBNP Methods: PEACE HF risk score was calculated for patients with available left ventricular ejection fraction and NTproBNP examined at the 1stand 5thvisit. Temporal change in PEACE score was analyzed and correlated with available NTproBNP levels Results: 1,840 ambulatory patients (60§9 years, 49% males) without a history of HF, coronary artery disease and cerebrovascular
164 Clinical Differences between Methamphetamine and Non-Methamphetamine Associated Non-Ischemic Dilated Cardiomyopathy Pavan Reddy, Kyle O’Meara, Sagar Patel, Edward Chau, Merije Chukumerije, Anil Mehra, Tien Ng, Uri Elkayam; University of Southern California, Keck Medical Center, Los Angeles, CA Background: Methamphetamine associated cardiomyopathy (MACM) is an increasingly recognized form of dilated cardiomyopathy around the globe which remains poorly characterized. Purpose: To compare the clinical characteristics of MACM to those of non-MA associated dilated CM (NMACM). Methods: Consecutive patients with MACM presenting to our institution between Jun 2018 and Jan 2019 were prospectively studied and compared to an age and gender matched cohort of dilated nonischemic CM cases. Results: Seventy patients were studied (35 MACM and 35 NMACM). Mean age was similar between groups (49§9 vs. 48§10 years, p=0.465) and 97% of patients were male. Median duration of MA use prior to cardiomyopathy diagnosis was 5 years (range 0-30). Patients were predominantly Hispanic in both
The 23rd Annual Scientific Meeting HFSA groups (48% vs. 62%, p=0.229), but with a greater proportion of Caucasians in the MACM group compared to NMACM (26% vs 6%,p=0.045).MACM was characterized by lower left ventricular ejection fraction (LVEF) and greater left ventricular end diastolic volume (LVEDV) compared to NMACM. RV dilation was present more often in MACM cases (Table). Years of MA use was associated with greater LA volumes (R2= 0.13, p=0.048). Association with larger LVEDV and incidence of RV dilation were borderline significant (R2= 0.11, p=0.054 and p=0.058 respectively). The amount of MA used per week correlated with higher RVSP (R2=0.317, p=0.004). Polysubstance abuse was associated with greater LVEF (p=0.028), lower LVEDV (p=0.037) and lower LV mass (p=0.004). Conclusions: MACM is associated with higher degree of LV and RV dilatation as well as LV systolic dysfunction when compared to matched NMACM cases. Years of MA use and amount MA consumed appear to influence severity of disease.
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male. Combination ICI was associated with increased risk of myocarditis (OR 1.85, 95% CI: 1.41-2.42, P<.001), but there was no difference in reported myocarditis between types of ICI. In adjusted analysis, reported myocarditis was associated with myositis (ROR 25.51 [18.67-34.85], P<0.001), encephalitis (ROR 2.94 [1.37-6.30], P=0.006) and hepatitis (ROR 2.91 [1.87-4.53], P<0.001), figure. When 2 of these high-risk irAEs were reported, the prevalence of reported myocarditis was 41.3% compared with 3.7% if one is reported, and 0.6% if no concomitant high-risk irAE is reported, P<0.001. Conclusions: ICI-associated myocarditis is associated with myositis, encephalitis, and hepatitis. The presence of either of this high-risk irAEs should raise suspicion for myocarditis.
165 Immune Checkpoint Inhibitors Associated with Cardiotoxicity in Cancer Patients: A Large Single-Center Experience Johnny Chahine1, Bicky Thapa1, Chandra K. Ala1, Pradnya Patil2, Pauline Funchain2, Anjli Maroo1, Allan L. Klein2, W.H. Wilson Tang2; 1Fairview Hospital, Cleveland, OH; 2Cleveland Clinic, Cleveland, OH Introduction: Immune checkpoint inhibitors (ICIs) promote immune cells to invade tumor cells. With the increasing use of ICIs, clinicians should be aware of the cardiac toxicity profile of ICIs in order to achieve timely intervention and better outcomes. We report our single-center experience of cardiac immunerelated adverse effects (CIRAEs) in patients treated with ICIs. Methods: We reviewed consecutive patients who received an ICI at the Cleveland Clinic between 2011 and 2018 for the occurrence of CIRAEs. Disease profile, hospital course, and outcome were studied in patients with CIRAEs. Results: Out of 2830 patients initiated on ICIs, 9 patients developed CIRAEs (0.3%). The mean age was 70 § 9 years, and 55% were males. Four patients developed cardiomyopathy, two patients had acute myocarditis, two patients had acute pericarditis, and one patient had a large pericardial effusion. Most presentations were atypical, and most patients had other associated immune-related adverse effects. The patients with acute myocarditis presented predominantly with symptoms of myasthenia gravis and myositis, while self-described as generalized weakness and fatigue. Patients with cardiomyopathy presented with shortness of breath at exertion, but also with chest pressure and symptoms of autoimmune pancreatitis. In addition to the typical pleuritic chest pain, patients with acute pericarditis manifested other respiratory symptoms (shortness of breath, productive cough) that might be due to their lung cancer or associated autoimmune pneumonitis. Both patients with myocarditis died within a week, reflective of the poor prognosis of myocarditis. All patients with cardiomyopathy except one recovered their systolic function after withholding ICIs. Interestingly, the patient who did not recover was not treated with high dose steroids during his hospitalization. Steroids were not needed in one case of acute pericarditis, and pericarditis did not recur in the patient with acute pericarditis after nivolumab reintroduction. Overall, five patients had no progression of their primary malignancy, two had progression, and the remaining two had a fatal outcome during the admission. Conclusions: The incidence of CIRAE with ICIs in our single-center experience was comparable to those reported in the literature. Patients treated with ICIs who present with chest pain, shortness of breath or generalized weakness should be evaluated for potential CIRAEs. The role of early steroid treatment for cardiac involvement should warrant further investigations.
166 Association between Myocarditis and Other Immune-Related Adverse Events Associated with Immune Checkpoint Inhibitor Use: Analysis of the FDA Adverse Events Reporting System (FAERS) Nour Tashtish1, Kate Lang2, Sadeer Al-Kindi1, Chantal Elamm1, Guilherme H. Oliveira1; 1University Hospital Cleveland Medical Center, Cleveland, OH; 2Case Western Reserve University, Cleveland, OH Background: Immune checkpoint inhibitors (ICI) are increasingly being used for the management of malignancies, but they are associated with immune-related adverse events (irAE). Myocarditis is a rare irAE that is associated with high mortality, and thus early diagnosis is essential. Because some myocarditis events are asymptomatic, it is important to suspect myocarditis in patients presenting with irAEs. The purpose of this study is to evaluate the association between myocarditis and other irAEs reported to the FDA, to identify high-risk patients that may benefit from screening for myocarditis. Hypothesis: We hypothesized that ICI- associated myocarditis is associated with other irAEs. Methods: Using the FDA Adverse Events Reporting System (FAERS), we identified all adverse events (AEs) associated with 5 ICIs (Nivolumab, Ipilimumab, Pembrolizumab, Atezolizumab, Durvalumab) between April 2011 and December 2018. We investigated the association between myocarditis and type of ICI, patient characteristics, and other concomitantly-reported irAE, using logistic regression and reporting odds ratio (ROR), adjusting for age, sex, reporting year, and combination ICIs. Results: There were a total of 398 myocarditis events reported during the study period, accounting for 0.7% of all 55,642 ICI-AEs, and 3.5% of 11,480 irAE events. Mean age for myocarditis 65.7§12.4 years, and 64.5% were
167 A Comparison of Echocardiographic Findings in Young Adults with Acute Decompensated Heart Failure Due to Methamphetamine-Associated, Alcoholic, and Idiopathic Cardiomyopathy Shazib Sagheer1, Amir H.A. Sohail2, Chih W. Chang1, Jerome P. Yatskowtiz1; 1University of New Mexico Hospital, Albuquerque, NM; 2Howard University Medical Center, Washington DC, DC Background: Methamphetamine is the most widespread illegal stimulant abused in the United States and the 3rd most common drug of abuse in the US after alcohol and opiates. New Mexico is one of the top ten states for methamphetamine use. No previous reports comparing echocardiographic findings of cardiomyopathy with and without a history of methamphetamine abuse in New Mexico are available. Objective: To define demographic and echocardiographic characteristics of patients admitted for acute decompensated heart failure with reduced ejection fraction due to methamphetamine-associated Cardiomyopathy (MA-CMP), during index hospitalization. To compare these characteristics to patients with alcoholic cardiomyopaty (ACMP) and Non ischemic cardiomyopathy(NICMP). Methods: We performed a single institution retrospective review of medical records and analyses of echocardiographic findings in patients 55 years of age hospitalized between 2008 and 2015 who were discharged with a diagnosis of acute decompensated heart failure after their index hospitalization. Patients with ischemic CMP, severe valvular disease, or left ventricular ejection fraction > 40% were excluded. The remaining patients were divided into three groups: no substance abuse, methamphetamine abusers, and alcohol only abusers- as determined by the documented history in the medical records or urine toxicology testing. For each of the three groups in addition to demographic findings following Echocardiographic parameters were collected: Left ventricular ejection fraction (LVEF), LV end-diastolic volume (LVEDV),and LV end-systolic volume (LVESV). Results: Among 225 patients who met inclusion criteria, 59 (26%) had MA-CMP, 42 (18%) A-CMP, and 124(54%) had NICMP. Multivariate linear regression analysis revealed that MA-CMP group had a lower EF of 19.93 (P <0.005; CI 6.03-33.83) compared with NICMP group with mean EF of 25.87 (P<0.026; CI 5.346). A-CMP group mean EF of 25 (P =0.128, CI 4.5-46) was not statistically significant. Mean LVESV of MA-CMP was 180ml (P<0.005; CI 134-221) compared to 149ml (P<0.002; CI 129-168), and 153ml (P <0.003; CI 140-172) for A-CMP and NICMP respectively. Similarly, mean LVEDV for MA-CMP group was 222ml (P<0.005; CI 179-266) compare to 193ml (P <0.007; CI 172-214), and 198ml (P <0.006; CI 183-215) for A-CMP and NICMP groups respectively. Conclusions: Patients with MA-CMP admitted for acute decompensated heart failure with reduced ejection fraction during index hospitalization tend to have echocardiographic findings of lower quantified LVEF, higher LVESV and LVEDV compare to patients with NICMP and alcoholic CMP related heart failure. We postulate different mechanism to explains this difference.
disease were followed for a median of 8 years. Patients were at low risk based on PEACE score and NTproBNP [median 46 (IQR 21-91)pg/mL]. Proportion of patients with PEACE risk score at average (n=227, 12.5%) or high risk (n=10, 0.6%) increased over time, which correlated with the increase in overall NT-proBNP levels over time (Figure, p<0.01). Interestingly, a subset of patients (n=196, 10%) at low risk by PEACE risk score had NTproBNP levels above 125 pg/mL despite eGFR >60. Conclusions: Proportion of patients at average and high risk for HF increase with time which correlated with NTproBNP levels. Mismatch between PEACE HF risk and NTproBNP was seen among low risk patients warranting further investigation.
162 Sacubitril-Valsartan Initiation Post-Left Ventricular Assist Device is Safe and Effective Varinder K. Randhawa, Lucianne West, Jacob Luthman, Jerry Estep, Edward G. Soltesz, Randall C. Starling; Cleveland Clinic Foundation, Cleveland, OH Introduction and Aim: Guideline-directed medical therapy for heart failure (HF) with reduced ejection fraction includes demonstrated benefit from the combination drug sacubitril-valsartan in acute and chronic heart failure. However, little is known of its’ tolerability in patients with stage D HF requiring durable left ventricular assist device (LVAD) implantation. Our aim was to determine its’ safety and efficacy in patients with durable LVADs. Methods: We retrospectively reviewed patients who were initiated on sacubitril-valsartan post-LVAD implantation at our institution for baseline characteristics and drug tolerability. Results: We identified 10 patients with a mean age of 57.5 § 8.7 years who were initiated on sacubitril-valsartan post-LVAD implantation, 80% for destination therapy. Of these, 4 had axial and 6 had centrifugal flow pumps. The majority were Caucasian (60%) and male (70%). The initiation of sacubitril-valsartan reduced MAP by 20.0 § 14.0 mmHg (p=0.002), and NT-proBNP from 2,929 pg/mL to 1,530 pg/mL (p=0.36). By contrast, mean serum creatinine and potassium were unaltered (Table 1). Only one patient experienced hyperkalemia, and no patients developed drug-related acute kidney injury (decline in eGFR >25%), hypotension or angioedema. Following the initiation of sacubitril-valsartan, there was a concomitant reduction in the use of other oral vasodilators (30-50%), mineralocorticoid receptor antagonists (20%), and non-potassium sparing diuretics (10%). Conclusions: Sacubitril-valsartan initiation in patients after LVAD implantation is tolerated, and reduces MAP. Elevated MAP has been related to adverse events post-LVAD and sacubitril-valsartan appears safe and effective in our preliminary experience in patients supported with continuous flow LVAD. Table 1. Table 1. Impact of Sacubitril-Valsartan on Clinical Variables.
Clinical Variable MAP (mm Hg) Potassium (mM) Creatinine (mg/dL) NT-proBNP (pg/mL)
Prior to SacubitrilValsartan Initiation
After SacubitrilValsartan Initiation
Delta Change With SacubitrilValsartan
P-value
98.8 § 12.2 4.14 § 0.66 1.28 § 0.26 2,929.5 § 5,013.26
78.4 § 12.1 4.34 § 0.36 1.39 § 0.26 1,530.0 § 1,676.34
(-) 20.0 § 14.0 (+) 0.11 § 0.44 (+) 0.08 § 0.17 (-) 1,631 § 5,194.18
p=0.002 p=0.46 p=0.21 p=0.36
163 Temporal Change in PEACE Heart Failure Risk Score and Association with Natriuretic Peptides in the MESA Population Abhinav Sood, Wilson W.H. Tang; Cleveland Clinic, Cleveland, OH Introduction: We assessed temporal evolution of the PEACE score, a validated heart failure (HF) prediction score, in the MESA population and its correlation with NTproBNP Hypothesis: PEACE risk score will increase with time and have a positive correlation with NTproBNP Methods: PEACE HF risk score was calculated for patients with available left ventricular ejection fraction and NTproBNP examined at the 1stand 5thvisit. Temporal change in PEACE score was analyzed and correlated with available NTproBNP levels Results: 1,840 ambulatory patients (60§9 years, 49% males) without a history of HF, coronary artery disease and cerebrovascular
164 Clinical Differences between Methamphetamine and Non-Methamphetamine Associated Non-Ischemic Dilated Cardiomyopathy Pavan Reddy, Kyle O’Meara, Sagar Patel, Edward Chau, Merije Chukumerije, Anil Mehra, Tien Ng, Uri Elkayam; University of Southern California, Keck Medical Center, Los Angeles, CA Background: Methamphetamine associated cardiomyopathy (MACM) is an increasingly recognized form of dilated cardiomyopathy around the globe which remains poorly characterized. Purpose: To compare the clinical characteristics of MACM to those of non-MA associated dilated CM (NMACM). Methods: Consecutive patients with MACM presenting to our institution between Jun 2018 and Jan 2019 were prospectively studied and compared to an age and gender matched cohort of dilated nonischemic CM cases. Results: Seventy patients were studied (35 MACM and 35 NMACM). Mean age was similar between groups (49§9 vs. 48§10 years, p=0.465) and 97% of patients were male. Median duration of MA use prior to cardiomyopathy diagnosis was 5 years (range 0-30). Patients were predominantly Hispanic in both
The 23rd Annual Scientific Meeting HFSA groups (48% vs. 62%, p=0.229), but with a greater proportion of Caucasians in the MACM group compared to NMACM (26% vs 6%,p=0.045).MACM was characterized by lower left ventricular ejection fraction (LVEF) and greater left ventricular end diastolic volume (LVEDV) compared to NMACM. RV dilation was present more often in MACM cases (Table). Years of MA use was associated with greater LA volumes (R2= 0.13, p=0.048). Association with larger LVEDV and incidence of RV dilation were borderline significant (R2= 0.11, p=0.054 and p=0.058 respectively). The amount of MA used per week correlated with higher RVSP (R2=0.317, p=0.004). Polysubstance abuse was associated with greater LVEF (p=0.028), lower LVEDV (p=0.037) and lower LV mass (p=0.004). Conclusions: MACM is associated with higher degree of LV and RV dilatation as well as LV systolic dysfunction when compared to matched NMACM cases. Years of MA use and amount MA consumed appear to influence severity of disease.
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male. Combination ICI was associated with increased risk of myocarditis (OR 1.85, 95% CI: 1.41-2.42, P<.001), but there was no difference in reported myocarditis between types of ICI. In adjusted analysis, reported myocarditis was associated with myositis (ROR 25.51 [18.67-34.85], P<0.001), encephalitis (ROR 2.94 [1.37-6.30], P=0.006) and hepatitis (ROR 2.91 [1.87-4.53], P<0.001), figure. When 2 of these high-risk irAEs were reported, the prevalence of reported myocarditis was 41.3% compared with 3.7% if one is reported, and 0.6% if no concomitant high-risk irAE is reported, P<0.001. Conclusions: ICI-associated myocarditis is associated with myositis, encephalitis, and hepatitis. The presence of either of this high-risk irAEs should raise suspicion for myocarditis.
165 Immune Checkpoint Inhibitors Associated with Cardiotoxicity in Cancer Patients: A Large Single-Center Experience Johnny Chahine1, Bicky Thapa1, Chandra K. Ala1, Pradnya Patil2, Pauline Funchain2, Anjli Maroo1, Allan L. Klein2, W.H. Wilson Tang2; 1Fairview Hospital, Cleveland, OH; 2Cleveland Clinic, Cleveland, OH Introduction: Immune checkpoint inhibitors (ICIs) promote immune cells to invade tumor cells. With the increasing use of ICIs, clinicians should be aware of the cardiac toxicity profile of ICIs in order to achieve timely intervention and better outcomes. We report our single-center experience of cardiac immunerelated adverse effects (CIRAEs) in patients treated with ICIs. Methods: We reviewed consecutive patients who received an ICI at the Cleveland Clinic between 2011 and 2018 for the occurrence of CIRAEs. Disease profile, hospital course, and outcome were studied in patients with CIRAEs. Results: Out of 2830 patients initiated on ICIs, 9 patients developed CIRAEs (0.3%). The mean age was 70 § 9 years, and 55% were males. Four patients developed cardiomyopathy, two patients had acute myocarditis, two patients had acute pericarditis, and one patient had a large pericardial effusion. Most presentations were atypical, and most patients had other associated immune-related adverse effects. The patients with acute myocarditis presented predominantly with symptoms of myasthenia gravis and myositis, while self-described as generalized weakness and fatigue. Patients with cardiomyopathy presented with shortness of breath at exertion, but also with chest pressure and symptoms of autoimmune pancreatitis. In addition to the typical pleuritic chest pain, patients with acute pericarditis manifested other respiratory symptoms (shortness of breath, productive cough) that might be due to their lung cancer or associated autoimmune pneumonitis. Both patients with myocarditis died within a week, reflective of the poor prognosis of myocarditis. All patients with cardiomyopathy except one recovered their systolic function after withholding ICIs. Interestingly, the patient who did not recover was not treated with high dose steroids during his hospitalization. Steroids were not needed in one case of acute pericarditis, and pericarditis did not recur in the patient with acute pericarditis after nivolumab reintroduction. Overall, five patients had no progression of their primary malignancy, two had progression, and the remaining two had a fatal outcome during the admission. Conclusions: The incidence of CIRAE with ICIs in our single-center experience was comparable to those reported in the literature. Patients treated with ICIs who present with chest pain, shortness of breath or generalized weakness should be evaluated for potential CIRAEs. The role of early steroid treatment for cardiac involvement should warrant further investigations.
166 Association between Myocarditis and Other Immune-Related Adverse Events Associated with Immune Checkpoint Inhibitor Use: Analysis of the FDA Adverse Events Reporting System (FAERS) Nour Tashtish1, Kate Lang2, Sadeer Al-Kindi1, Chantal Elamm1, Guilherme H. Oliveira1; 1University Hospital Cleveland Medical Center, Cleveland, OH; 2Case Western Reserve University, Cleveland, OH Background: Immune checkpoint inhibitors (ICI) are increasingly being used for the management of malignancies, but they are associated with immune-related adverse events (irAE). Myocarditis is a rare irAE that is associated with high mortality, and thus early diagnosis is essential. Because some myocarditis events are asymptomatic, it is important to suspect myocarditis in patients presenting with irAEs. The purpose of this study is to evaluate the association between myocarditis and other irAEs reported to the FDA, to identify high-risk patients that may benefit from screening for myocarditis. Hypothesis: We hypothesized that ICI- associated myocarditis is associated with other irAEs. Methods: Using the FDA Adverse Events Reporting System (FAERS), we identified all adverse events (AEs) associated with 5 ICIs (Nivolumab, Ipilimumab, Pembrolizumab, Atezolizumab, Durvalumab) between April 2011 and December 2018. We investigated the association between myocarditis and type of ICI, patient characteristics, and other concomitantly-reported irAE, using logistic regression and reporting odds ratio (ROR), adjusting for age, sex, reporting year, and combination ICIs. Results: There were a total of 398 myocarditis events reported during the study period, accounting for 0.7% of all 55,642 ICI-AEs, and 3.5% of 11,480 irAE events. Mean age for myocarditis 65.7§12.4 years, and 64.5% were
167 A Comparison of Echocardiographic Findings in Young Adults with Acute Decompensated Heart Failure Due to Methamphetamine-Associated, Alcoholic, and Idiopathic Cardiomyopathy Shazib Sagheer1, Amir H.A. Sohail2, Chih W. Chang1, Jerome P. Yatskowtiz1; 1University of New Mexico Hospital, Albuquerque, NM; 2Howard University Medical Center, Washington DC, DC Background: Methamphetamine is the most widespread illegal stimulant abused in the United States and the 3rd most common drug of abuse in the US after alcohol and opiates. New Mexico is one of the top ten states for methamphetamine use. No previous reports comparing echocardiographic findings of cardiomyopathy with and without a history of methamphetamine abuse in New Mexico are available. Objective: To define demographic and echocardiographic characteristics of patients admitted for acute decompensated heart failure with reduced ejection fraction due to methamphetamine-associated Cardiomyopathy (MA-CMP), during index hospitalization. To compare these characteristics to patients with alcoholic cardiomyopaty (ACMP) and Non ischemic cardiomyopathy(NICMP). Methods: We performed a single institution retrospective review of medical records and analyses of echocardiographic findings in patients 55 years of age hospitalized between 2008 and 2015 who were discharged with a diagnosis of acute decompensated heart failure after their index hospitalization. Patients with ischemic CMP, severe valvular disease, or left ventricular ejection fraction > 40% were excluded. The remaining patients were divided into three groups: no substance abuse, methamphetamine abusers, and alcohol only abusers- as determined by the documented history in the medical records or urine toxicology testing. For each of the three groups in addition to demographic findings following Echocardiographic parameters were collected: Left ventricular ejection fraction (LVEF), LV end-diastolic volume (LVEDV),and LV end-systolic volume (LVESV). Results: Among 225 patients who met inclusion criteria, 59 (26%) had MA-CMP, 42 (18%) A-CMP, and 124(54%) had NICMP. Multivariate linear regression analysis revealed that MA-CMP group had a lower EF of 19.93 (P <0.005; CI 6.03-33.83) compared with NICMP group with mean EF of 25.87 (P<0.026; CI 5.346). A-CMP group mean EF of 25 (P =0.128, CI 4.5-46) was not statistically significant. Mean LVESV of MA-CMP was 180ml (P<0.005; CI 134-221) compared to 149ml (P<0.002; CI 129-168), and 153ml (P <0.003; CI 140-172) for A-CMP and NICMP respectively. Similarly, mean LVEDV for MA-CMP group was 222ml (P<0.005; CI 179-266) compare to 193ml (P <0.007; CI 172-214), and 198ml (P <0.006; CI 183-215) for A-CMP and NICMP groups respectively. Conclusions: Patients with MA-CMP admitted for acute decompensated heart failure with reduced ejection fraction during index hospitalization tend to have echocardiographic findings of lower quantified LVEF, higher LVESV and LVEDV compare to patients with NICMP and alcoholic CMP related heart failure. We postulate different mechanism to explains this difference.