Point-of-care Ultrasound for Detecting Methamphetamine-associated Heart Failure in the Emergency Department

Q: What are the key findings of this study?

Cardiac point-of-care ultrasound in the emergency department detected reduced left ventricular ejection fraction in 31.4% of methamphetamine users compared to 5.8% of non-users.

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Methamphetamine-associated heart failure (n=136). Intervention: Methamphetamine use vs. Non-users. Primary outcome: Diagnostic yield of cardiac POCUS for reduced left ventricular ejection fraction (< 40%) (p=<0.001).

Q: What does this research mean for the field?

Cardiac point-of-care ultrasound in the emergency department identifies reduced left ventricular ejection fraction in 31.4% of methamphetamine users compared to 5.8% of non-users. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To assess the diagnostic yield of physician-performed cardiac point-of-care ultrasound for detecting heart failure with reduced ejection fraction and left ventricular enlargement in emergency department patients who use methamphetamine.

Madison Nashu; Jordan Lam; Zarak Khan; Soheil Saadat; Roy Almog; Ron Goubert; Joshua Wasmund; Heesun Choi; Shadi Lahham; Edmund Hsu; Megan Guy; Fox Jc

doi:10.5811/westjem.53982

July 17, 2026Western Journal of Emergency MedicineOpen Access

Point-of-care Ultrasound for Detecting Methamphetamine-associated Heart Failure in the Emergency Department

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Key result

Methamphetamine use linked to ~5-fold higher rate of reduced LVEF on emergency POCUS.

P<0.001
n=136

Why the study?

Methamphetamine-associated heart failure with reduced ejection fraction is often underrecognized in the emergency department, and the diagnostic yield of point-of-care ultrasound for this condition was not established.

Does cardiac point-of-care ultrasound detect a higher rate of reduced LVEF and abnormal left ventricular dilation in emergency department patients with methamphetamine use compared to non-users?

Key Points

To assess the diagnostic yield of physician-performed cardiac point-of-care ultrasound for detecting heart failure with reduced ejection fraction and left ventricular enlargement in emergency department patients who use methamphetamine.
Conducted a prospective cohort study between December 2020 and February 2024 at an urban Level I trauma center emergency department enrolling 136 patients (84 methamphetamine users and 52 non-users).
Physician-performed point-of-care ultrasound evaluated left ventricular ejection fraction using E-point septal separation (abnormal defined as < 40%) and sex-specific left ventricular end-diastolic diameter.
Calculated diagnostic yield as the proportion of completed examinations identifying abnormalities and assessed associations with drug use duration and frequency.
In methamphetamine users, cardiac point-of-care ultrasound detected reduced left ventricular ejection fraction in 22 of 70 patients (31.4% [95% CI, 20.9-43.6%]) compared with 3 of 52 non-users (5.8% [95% CI, 1.2-16.0%]; P < .001).
Any sex-specific left ventricular end-diastolic diameter abnormality was present in 30 of 84 users (35.7% [95% CI, 25.6-46.9%]) versus 10 of 52 non-users (19.2% [95% CI, 9.6-32.5%]; P = .05), with severe abnormalities in 15 of 84 (17.9%) versus 3 of 52 (5.8%; P = .07).
After adjusting for hypertension, reduced ejection fraction was significantly associated with longer duration (OR 6.05, 95% CI, 1.46-25.10) and higher frequency (OR 5.93, 95% CI, 1.52-23.06) of methamphetamine use.

Study Design

Type

Cohort (n=136)

Blinding

None

Multicenter

No

Structured PICO

Does cardiac point-of-care ultrasound detect a higher rate of reduced LVEF and abnormal left ventricular dilation in emergency department patients with methamphetamine use compared to non-users?

P

Population

136 adult emergency department patients, comprising 84 with a history of methamphetamine use and 52 non-users, were prospectively evaluated with cardiac point-of-care ultrasound.

E

Exposure

Physician-performed cardiac point-of-care ultrasound (POCUS) to assess left ventricular ejection fraction (LVEF) via E-point septal separation and left ventricular end-diastolic diameter.

C

Comparator

Patients with no history of methamphetamine use undergoing the same cardiac POCUS assessment.

O

Outcome

Diagnostic yield of cardiac POCUS for abnormal left ventricular ejection fraction (< 40%) and abnormal sex-specific left ventricular end-diastolic diameter.surrogate

Main Result

Absolute Event Rate: 31.4% vs 5.8%

p-value: p=<0.001

Limitations

Convenience sample from a single academic medical center may limit generalizability
Non-English-speaking patients were excluded
Physicians performing POCUS were not blinded to patient exposure status, potentially introducing measurement bias
POCUS findings were not validated against formal echocardiography
Self-reporting and recall bias regarding the duration and frequency of methamphetamine use
Convenience sampling with restricted enrollment hours (8 am to midnight)
Physicians performing POCUS were not blinded to patient exposure status
POCUS findings were not validated against a formal echocardiography gold standard
Inability to control for confounders such as additional polysubstance use
Reliance on self-reported data subject to recall bias and reporting bias for a stigmatized substance

Implication

Cardiac point-of-care ultrasound (POCUS) demonstrates a high diagnostic yield for identifying early-onset, often asymptomatic heart failure with reduced ejection fraction in emergency department patients who use methamphetamine.

Abstract

INTRODUCTION: Methamphetamine-associated heart failure with reduced ejection fraction is a serious consequence of methamphetamine use often underrecognized in the emergency department (ED). Point-of-care ultrasound (POCUS) offers rapid, non-invasive cardiac screening for high-risk populations. This study evaluated the diagnostic yield of POCUS for detecting methamphetamine-associated heart failure with reduced ejection fraction in ED patients who use methamphetamine. METHODS: We conducted this prospective cohort study between December 2020-February 2024 at an urban Level I trauma center ED. The primary outcome was diagnostic yield of cardiac POCUS for abnormal left ventricular ejection fraction (LVEF) and abnormal sex-specific left ventricular end-diastolic diameter in patients with methamphetamine use, with secondary analyses assessing associations with use duration and frequency. Diagnostic yield was calculated as the proportion of completed POCUS examinations identifying abnormalities. We used E-point septal separation to calculate LVEF; < 40% was abnormal. Left ventricular end-diastolic diameter abnormality (> 5.8 cm males, > 5.2 cm females) was categorized as mild, moderate, or severe (mild, 5.9-6.3/5.3-5.6; moderate, 6.4-6.8/5.7-6.1; severe, > 6.8/> 6.1 cm males/females). Physician-performed POCUS assessed LVEF and left ventricular end-diastolic diameter in patients with a methamphetamine use history and a comparison group of non-users. RESULTS: Of the 136 enrolled patients, 84 (61.8%) reported methamphetamine use. Among methamphetamine users, diagnostic yield of cardiac POCUS was as follows: reduced LVEF in 22 of 70 with measurable LVEF (31.4% [20.9-43.6%]); any sex-specific left ventricular end-diastolic diameter abnormality in 30 of 84 (35.7% [25.6-46.9%]); and severe sex-specific left ventricular end-diastolic diameter abnormality in 15 of 84 (17.9% [10.4-27.7%]). Corresponding values in non-users were 3 of 52 (5.8% [1.2-16.0%]; P < .001), 10 of 52 (19.2% [9.6-32.5%]; P = .05), and 3 of 52 (5.8% [1.2 - 16.0%]; P = .07), respectively. Longer duration (odds ratio [OR] 6.05, 95% confidence interval [CI] 1.46-25.10) and higher frequency (OR 5.93, 95% CI, 1.52-23.06) of methamphetamine use were associated with reduced LVEF. CONCLUSION: Cardiac point-of-care ultrasound demonstrated a clinically significant diagnostic yield in detecting methamphetamine-associated heart failure with reduced ejection fraction among methamphetamine users in the ED, suggesting POCUS could aid early detection in this population, potentially streamlining management before disease progression.

Discussion

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Cite This Study

Nashu et al. (2026) conducted a cohort in Methamphetamine-associated heart failure (n=136). Methamphetamine use vs. Non-users was evaluated on Diagnostic yield of cardiac POCUS for reduced left ventricular ejection fraction (< 40%) (p=<0.001). Cardiac point-of-care ultrasound in the emergency department detected reduced left ventricular ejection fraction in 31.4% of methamphetamine users compared to 5.8% of non-users.

synapsesocial.com/papers/6ad0fc263afa093ea9acfcd9 https://doi.org/10.5811/westjem.53982

Topics

HFrEF treatment

Heart failure

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Point-of-care Ultrasound for Detecting Methamphetamine-associated Heart Failure in the Emergency Department

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Topics

Point-of-care Ultrasound for Detecting Methamphetamine-associated Heart Failure in the Emergency Department

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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