Research Article: Micromorphological changes in cardiac tissue of drug-related deaths with emphasis on chronic illicit opioid abuse

Date Published: July 12, 2013

Publisher: Blackwell Publishing Ltd

Author(s): Monika H Seltenhammer, Katharina Marchart, Pia Paula, Nicole Kordina, Nikolaus Klupp, Barbara Schneider, Christine Fitzl, Daniele U Risser.


The main intention of this retrospective study was to investigate whether chronic illicit drug abuse, especially the intravenous use of opioids (heroin), could potentially trigger the development of myocardial fibrosis in drug addicts.

A retrospective case–control study was performed using myocardial tissue samples from both drug-related deaths (DRD) with verifiable opioid abuse and non-drug-related deaths in the same age group.

Department of Forensic Medicine, Medical University of Vienna, Austria (1993–94).

Myocardial specimens were retrieved from 76 deceased intravenous opioid users and compared to those of 23 deceased non-drug users.

Drug quantification was carried out using the enzyme-multiplied immunoassay technique (EMIT), followed by [gas chromatography–mass spectrometry (GC–MS), MAT 112®], and analysed using the Integrator 3390A by Hewlett Packard® and LABCOM.1 computer (MSS-G.G.). The amount of fibrous connective tissue (FCT) in the myocardium was determined by using the morphometric software LUCIA Net version 1.16.2©, Laboratory Imaging, with NIS Elements 3.0®.

Drug analysis revealed that 67.11% were polydrug users and the same proportion was classified as heroin addicts (6-monoacetylmorphine, 6-MAM)—32.89% were users of pure heroin. In 76.32% of DRD cases, codeine was detected. Only 2.63% consumed cocaine. The mean morphine concentrations were 389.03 ng/g in the cerebellum and 275.52 ng/g in the medulla oblongata, respectively. Morphometric analysis exhibited a strong correlation between DRD and myocardial fibrosis. The mean proportion of FCT content in the drug group was 7.6 ± 2.9% (females: 6.30 ± 2.19%; males: 7.91 ± 3.01%) in contrast to 5.2 ± 1.7% (females: 4.45 ± 1.23%; males: 5.50 ± 1.78%) in the control group, indicating a significant difference (P = 0.0012), and a significant difference in the amount of FCT between females and males (P = 0.0383). There was no significant interaction of age and FCT (P = 0.8472).

There is a long-term risk of cardiac dysfunction following chronic illicit drug abuse with opioids as a principal component. Regular cardiological examination of patients receiving substitution treatment with morphine is strongly recommended.

Partial Text

Irrespective of the noticeable decline in the demand for drugs in recent years, the illegal use of drugs remains a global affair which represents an increasing health problem, particularly in people of younger ages. In the World Drug Report of 2011, the United Nations Office on Drugs and Crime (UNODC) estimates that, in 2009, between 149 and 272 million people, or 3.3 and 6.1% of the global population aged 15–64 years, used illicit substances at least once a year. Among all drug-dependent people world-wide, an estimated 12–21 (mid-point: 16.5) million people are chronic opiate addicts. Heroin is the most commonly used opiate, consumed by about three-quarters of global opiate users. In 2009, there were an estimated 12–14 million opiate users world-wide 1. Heroin is also the main opiate used in Europe. Its prevalence is estimated at 0.6% of the population aged 15–64, or between 3.1 and 3.5 million people. In Austria, a small country in central Europe with approximately 8 million inhabitants, the estimated prevalence is 0.41% 1, where the gender distribution is 0.9% males and 0.2% females, as stated by Uhl et al. 2. Uhl & Seidler 3 estimated that there are 17 276 opioid users in Austria and 10 953 in Vienna, the Austrian capital, with a population of almost 1.8 million. Similarly, according to the Austrian Federal Institute for Public Health and Klupp et al., opiate-related deaths represent as much as 80% of all drug-related deaths (DRD) in Austria 4,5, the majority of which again occur in Vienna.

The findings presented in this retrospective study indicate clearly that there is a strong correlation between long-term opioid-accentuated drug abuse and fibrotic alterations in the myocardium.




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