{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,5]],"date-time":"2026-11-05T23:56:55Z","timestamp":1793923015606,"version":"4.8.0"},"reference-count":44,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2021,4,1]],"date-time":"2021-04-01T00:00:00Z","timestamp":1617235200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":["www.atsjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,4,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>Single-center studies demonstrated that methamphetamine use is associated with pulmonary arterial hypertension (Meth-APAH). We used the Pulmonary Hypertension Association Registry to evaluate the national distribution of Meth-APAH and to compare its impact on patient-reported and clinical outcomes relative to idiopathic PAH.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To determine if patients with Meth-APAH differ from those with idiopathic PAH in demographics, regional distribution in the United States, hemodynamics, health-related quality of life, PAH-specific treatment, and health care use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>The Pulmonary Hypertension Association Registry is a U.S.-based prospective cohort of patients new to care at a Pulmonary Hypertension Care Center. The registry collects baseline demographics, clinical parameters, and repeated measures of health-related quality of life, World Health Organization functional class, 6-minute walk distance, therapy, and health care use. Repeated measures of functional class, health-related quality of life, type of therapy, emergency department visits, and hospitalizations were compared using generalized estimating equations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 541 participants included, 118 had Meth-APAH; 83% of Meth-APAH arose in the western United States. The Meth-APAH group was younger and had a poorer socioeconomic status and lower cardiac index than the idiopathic PAH group, despite no difference in mean pulmonary artery pressure or pulmonary vascular resistance. The Meth-APAH group had a more advanced functional class in longitudinal models (0.22 points greater; 95% confidence interval [CI], 0.07 to 0.37) and worse PAH-specific (emPHasis-10) health-related quality of life (\u22125.4; 95% CI, \u22128.1 to \u22122.8). There was no difference in dual combination therapy; however, participants with Meth-APAH were less likely to be initiated on triple therapy (odds ratio [OR], 0.43; 95% CI, 0.24 to 0.77) or parenteral therapy (OR, 0.10; 95% CI, 0.04 to 0.24). Participants with Meth-APAH were more likely to seek care in the emergency department (incidence rate ratio, 2.30; 95% CI, 1.71 to 3.11) and more likely to be hospitalized (incidence rate ratio, 1.42; 95% CI, 1.10 to 1.83).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Meth-APAH represents a unique clinical phenotype of PAH, most common in the western United States. It accounts for a notable proportion of PAH in expert centers. Assessment for methamphetamine use is necessary in patients with PAH.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1513\/annalsats.202007-774oc","type":"journal-article","created":{"date-parts":[[2020,10,16]],"date-time":"2020-10-16T17:58:51Z","timestamp":1602871131000},"page":"613-622","update-policy":"https:\/\/doi.org\/10.1164\/crossmarkpolicies","source":"Crossref","is-referenced-by-count":64,"title":["Clinical Differences and Outcomes between Methamphetamine-associated and Idiopathic Pulmonary Arterial Hypertension in the Pulmonary Hypertension Association Registry"],"prefix":"10.1093","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4586-959X","authenticated-orcid":false,"given":"Nicholas A.","family":"Kolaitis","sequence":"first","affiliation":[{"name":"Department of Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roham T.","family":"Zamanian","sequence":"additional","affiliation":[{"name":"Department of Medicine, Stanford University School of Medicine, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinicio A.","family":"de Jesus Perez","sequence":"additional","affiliation":[{"name":"Department of Medicine, Stanford University School of Medicine, Palo Alto, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David B.","family":"Badesch","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Colorado Health Sciences Center, Aurora, Colorado"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond L.","family":"Benza","sequence":"additional","affiliation":[{"name":"Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles D.","family":"Burger","sequence":"additional","affiliation":[{"name":"Department of Medicine, Mayo Clinic Florida, Jacksonville, Florida"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Murali M.","family":"Chakinala","sequence":"additional","affiliation":[{"name":"Department of Medicine, Washington University, St. Louis, Missouri"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean M.","family":"Elwing","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Cincinnati, Cincinnati, Ohio"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy","family":"Feldman","sequence":"additional","affiliation":[{"name":"Arizona Pulmonary Specialists, Phoenix, Arizona"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew R.","family":"Lammi","sequence":"additional","affiliation":[{"name":"Comprehensive Pulmonary Hypertension Center-University Medical Center, Louisiana State University, New Orleans, Louisiana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen C.","family":"Mathai","sequence":"additional","affiliation":[{"name":"Department of Medicine, Johns Hopkins University, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John W.","family":"McConnell","sequence":"additional","affiliation":[{"name":"Kentuckiana Pulmonary Research Center, Kentuckiana Pulmonary Associates, Louisville, Kentucky"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kenneth W.","family":"Presberg","sequence":"additional","affiliation":[{"name":"Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey C.","family":"Robinson","sequence":"additional","affiliation":[{"name":"The Oregon Clinic, Portland, Oregon"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey","family":"Sager","sequence":"additional","affiliation":[{"name":"Cottage Pulmonary Hypertension Center, Cottage Health, Santa Barbara, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oksana A.","family":"Shlobin","sequence":"additional","affiliation":[{"name":"Advanced Lung Disease and Lung Transplant Program, Inova Fairfax Medical Campus, Falls Church, Virginia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marc A.","family":"Simon","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven M.","family":"Kawut","sequence":"additional","affiliation":[{"name":"Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David V.","family":"Glidden","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, University of California, San Francisco School of Medicine, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0224-7472","authenticated-orcid":false,"given":"Jonathan P.","family":"Singer","sequence":"additional","affiliation":[{"name":"Department of Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teresa","family":"De Marco","sequence":"additional","affiliation":[{"name":"Department of Medicine and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,4,1]]},"reference":[{"issue":"25","key":"2026012203475350300_bib1","doi-asserted-by":"crossref","first-page":"D51","DOI":"10.1016\/j.jacc.2013.10.023","article-title":"Pulmonary arterial hypertension: epidemiology and registries","volume":"62","author":"McGoon","year":"2013","journal-title":"J Am Coll Cardiol"},{"key":"2026012203475350300_bib2","doi-asserted-by":"crossref","first-page":"1976","DOI":"10.1016\/j.jacc.2015.03.540","article-title":"Management of pulmonary arterial hypertension","volume":"65","author":"McLaughlin","year":"2015","journal-title":"J Am Coll Cardiol"},{"key":"2026012203475350300_bib3","doi-asserted-by":"crossref","first-page":"608","DOI":"10.1183\/09031936.00161410","article-title":"Comparison of cardiac and pulmonary-specific quality-of-life measures in pulmonary arterial hypertension","volume":"38","author":"Chen","year":"2011","journal-title":"Eur Respir J"},{"key":"2026012203475350300_bib4","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1183\/09059180.00003313","article-title":"Drug-induced pulmonary arterial hypertension: a recent outbreak","volume":"22","author":"Montani","year":"2013","journal-title":"Eur Respir Rev"},{"key":"2026012203475350300_bib5","doi-asserted-by":"crossref","first-page":"1801913","DOI":"10.1183\/13993003.01913-2018","article-title":"Haemodynamic definitions and updated clinical classification of pulmonary hypertension","volume":"53","author":"Simonneau","year":"2019","journal-title":"Eur Respir J"},{"key":"2026012203475350300_bib6","doi-asserted-by":"crossref","first-page":"614","DOI":"10.1378\/chest.104.2.614","article-title":"Pulmonary hypertension associated with long-term inhalation of \u201ccrank\u201d methamphetamine","volume":"104","author":"Schaiberger","year":"1993","journal-title":"Chest"},{"key":"2026012203475350300_bib7","first-page":"1283","article-title":"[Pulmonary arterial hypertension due to the use of amphetamines as drugs or doping] [in Dutch]","volume":"149","author":"van Wolferen","year":"2005","journal-title":"Ned Tijdschr Geneeskd"},{"key":"2026012203475350300_bib8","doi-asserted-by":"crossref","first-page":"1657","DOI":"10.1378\/chest.130.6.1657","article-title":"Is methamphetamine use associated with idiopathic pulmonary arterial hypertension?","volume":"130","author":"Chin","year":"2006","journal-title":"Chest"},{"key":"2026012203475350300_bib9","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1164\/rccm.201705-0943OC","article-title":"Features and outcomes of methamphetamine-associated pulmonary arterial hypertension","volume":"197","author":"Zamanian","year":"2018","journal-title":"Am J Respir Crit Care Med"},{"key":"2026012203475350300_bib10","doi-asserted-by":"crossref","first-page":"1802148","DOI":"10.1183\/13993003.02148-2018","article-title":"An overview of the 6th World Symposium on pulmonary hypertension","volume":"53","author":"Gali\u00e8","year":"2019","journal-title":"Eur Respir J"},{"key":"2026012203475350300_bib11","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1097\/MCP.0000000000000513","article-title":"Methamphetamine and the risk of pulmonary arterial hypertension","volume":"24","author":"Ramirez","year":"2018","journal-title":"Curr Opin Pulm Med"},{"key":"2026012203475350300_bib12","doi-asserted-by":"crossref","first-page":"1412","DOI":"10.1378\/chest.07-0235","article-title":"Methamphetamine and idiopathic pulmonary arterial hypertension: role of the serotonin transporter","volume":"132","author":"Rothman","year":"2007","journal-title":"Chest"},{"key":"2026012203475350300_bib13","article-title":"Emergency department visits involving methamphetamine: 2007 to 2011","volume-title":"The CBHSQ Report.","author":"Mattson","year":"2013"},{"key":"2026012203475350300_bib14","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1016\/j.drugalcdep.2012.11.016","article-title":"Methamphetamine use: a comprehensive review of molecular, preclinical and clinical findings","volume":"129","author":"Panenka","year":"2013","journal-title":"Drug Alcohol Depend"},{"key":"2026012203475350300_bib15","author":"Center for Behavioral Health Statistics and Quality"},{"key":"2026012203475350300_bib16","author":"United Nations Office on Drugs and Crime","year":"2016"},{"key":"2026012203475350300_bib17","doi-asserted-by":"crossref","first-page":"185","DOI":"10.21693\/1933-088X-16.4.185","article-title":"The pulmonary hypertension association registry: rationale, design, and role in quality improvement","volume":"16","author":"Gray","year":"2018","journal-title":"Adv Pulm Hypertens"},{"key":"2026012203475350300_bib18","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1016\/j.healun.2020.05.005","article-title":"Age-related differences in hemodynamics and functional status in pulmonary arterial hypertension: baseline results from the Pulmonary Hypertension Association Registry","volume":"39","author":"DesJardin","year":"2020","journal-title":"J Heart Lung Transplant"},{"key":"2026012203475350300_bib19","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1002\/bimj.201600107","article-title":"Optimal design of longitudinal data analysis using generalized estimating equation models","volume":"59","author":"Liu","year":"2017","journal-title":"Biom J"},{"key":"2026012203475350300_bib20","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1002\/mpr.329","article-title":"Multiple imputation by chained equations: what is it and how does it work?","volume":"20","author":"Azur","year":"2011","journal-title":"Int J Methods Psychiatr Res"},{"key":"2026012203475350300_bib21","doi-asserted-by":"crossref","first-page":"377","DOI":"10.1002\/sim.4067","article-title":"Multiple imputation using chained equations: issues and guidance for practice","volume":"30","author":"White","year":"2011","journal-title":"Stat Med"},{"key":"2026012203475350300_bib22","first-page":"A2512","article-title":"Comparison of risk discrimination between the REVEAL 2.0 calculators, the French Pulmonary Registry Algorithm and the Bologna method in patients with Pulmonary Arterial Hypertension (PAH) [abstract]","volume":"199","author":"Benza","year":"2019","journal-title":"Am J Respir Crit Care Med"},{"key":"2026012203475350300_bib23","volume-title":"Methamphetamine: a regional drug crisis.","author":"Artigiani"},{"key":"2026012203475350300_bib24","author":"DEA"},{"key":"2026012203475350300_bib25","volume-title":"Treatment episode data set: national admissions to substance abuse treatment services","author":"Substance Abuse and Mental Health Services Administration","year":"2017"},{"key":"2026012203475350300_bib26","doi-asserted-by":"crossref","first-page":"114543","DOI":"10.1016\/j.taap.2019.03.015","article-title":"Methamphetamine produces cardiac damage and apoptosis by decreasing melusin","volume":"378","author":"Sun","year":"2019","journal-title":"Toxicol Appl Pharmacol"},{"key":"2026012203475350300_bib27","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1016\/j.cbi.2011.01.025","article-title":"Water-restraint stress enhances methamphetamine-induced cardiotoxicity","volume":"190","author":"Tomita","year":"2011","journal-title":"Chem Biol Interact"},{"key":"2026012203475350300_bib28","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s40199-017-0170-4","article-title":"Histopathological study of cardiac lesions in methamphetamine poisoning-related deaths","volume":"25","author":"Akhgari","year":"2017","journal-title":"Daru"},{"key":"2026012203475350300_bib29","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1016\/j.jchf.2017.02.017","article-title":"Clinical characteristics, histopathological features, and clinical outcome of methamphetamine-associated cardiomyopathy","volume":"5","author":"Sch\u00fcrer","year":"2017","journal-title":"JACC Heart Fail"},{"key":"2026012203475350300_bib30","doi-asserted-by":"crossref","first-page":"1353","DOI":"10.1111\/j.1360-0443.2008.02231.x","article-title":"Methamphetamine-related fatalities in Australia: demographics, circumstances, toxicology and major organ pathology","volume":"103","author":"Kaye","year":"2008","journal-title":"Addiction"},{"key":"2026012203475350300_bib31","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1016\/j.drugalcdep.2017.07.001","article-title":"Prevalence and nature of cardiovascular disease in methamphetamine-related death: a national study","volume":"179","author":"Darke","year":"2017","journal-title":"Drug Alcohol Depend"},{"key":"2026012203475350300_bib32","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/j.jchf.2017.10.006","article-title":"Clinical characteristics and outcome of methamphetamine-associated pulmonary arterial hypertension and dilated cardiomyopathy","volume":"6","author":"Zhao","year":"2018","journal-title":"JACC Heart Fail"},{"key":"2026012203475350300_bib33","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1016\/j.jacc.2016.10.047","article-title":"The relationship between the right ventricle and its load in Pulmonary hypertension","volume":"69","author":"Vonk Noordegraaf","year":"2017","journal-title":"J Am Coll Cardiol"},{"key":"2026012203475350300_bib34","doi-asserted-by":"crossref","first-page":"182","DOI":"10.1016\/j.addbeh.2015.06.040","article-title":"Evaluation of methamphetamine-associated socioeconomic status and addictive behaviors, and their impact on oral health","volume":"50","author":"Rommel","year":"2015","journal-title":"Addict Behav"},{"key":"2026012203475350300_bib35","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.drugalcdep.2016.10.001","article-title":"Barriers to accessing methamphetamine treatment: a systematic review and meta-analysis","volume":"168","author":"Cumming","year":"2016","journal-title":"Drug Alcohol Depend"},{"key":"2026012203475350300_bib36","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1007\/BF03256141","article-title":"Oral therapies for the treatment of pulmonary arterial hypertension: a population-based cost-minimization analysis","volume":"7","author":"Dranitsaris","year":"2009","journal-title":"Appl Health Econ Health Policy"},{"key":"2026012203475350300_bib37","doi-asserted-by":"crossref","first-page":"2522","DOI":"10.1056\/NEJMoa1503184","article-title":"Selexipag for the treatment of pulmonary arterial hypertension","volume":"373","author":"Sitbon","year":"2015","journal-title":"N Engl J Med"},{"key":"2026012203475350300_bib38","doi-asserted-by":"crossref","first-page":"296","DOI":"10.1056\/NEJM199602013340504","article-title":"A comparison of continuous intravenous epoprostenol (prostacyclin) with conventional therapy for primary pulmonary hypertension","volume":"334","author":"Barst","year":"1996","journal-title":"N Engl J Med"},{"key":"2026012203475350300_bib39","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.1164\/rccm.200510-1668OC","article-title":"Pulmonary arterial hypertension in France: results from a national registry","volume":"173","author":"Humbert","year":"2006","journal-title":"Am J Respir Crit Care Med"},{"key":"2026012203475350300_bib40","doi-asserted-by":"crossref","first-page":"1043","DOI":"10.1378\/chest.15-0300","article-title":"Five-year outcomes of patients enrolled in the REVEAL registry","volume":"148","author":"Farber","year":"2015","journal-title":"Chest"},{"key":"2026012203475350300_bib41","doi-asserted-by":"crossref","first-page":"518","DOI":"10.1183\/09031936.02.01762002","article-title":"BMPR2 germline mutations in pulmonary hypertension associated with fenfluramine derivatives","volume":"20","author":"Humbert","year":"2002","journal-title":"Eur Respir J"},{"key":"2026012203475350300_bib42","doi-asserted-by":"crossref","first-page":"1700217","DOI":"10.1183\/13993003.00217-2017","article-title":"Long-term outcomes of dasatinib-induced pulmonary arterial hypertension: a population-based study","volume":"50","author":"Weatherald","year":"2017","journal-title":"Eur Respir J"},{"key":"2026012203475350300_bib43","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1016\/j.amjcard.2013.04.051","article-title":"Effectiveness of spironolactone plus ambrisentan for treatment of pulmonary arterial hypertension (from the [ARIES] study 1 and 2 trials)","volume":"112","author":"Maron","year":"2013","journal-title":"Am J Cardiol"},{"key":"2026012203475350300_bib44","doi-asserted-by":"crossref","first-page":"e027193","DOI":"10.1136\/bmjopen-2018-027193","article-title":"Screening of Pulmonary Hypertension in Methamphetamine Abusers (SOPHMA): rationale and design of a multicentre, cross-sectional study","volume":"9","author":"Cheng","year":"2019","journal-title":"BMJ Open"}],"updated-by":[{"DOI":"10.1513\/annalsats.v19erratum4","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2022,6,30]],"date-time":"2022-06-30T00:00:00Z","timestamp":1656547200000}}],"container-title":["Annals of the American Thoracic Society"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/annalsats\/article-pdf\/18\/4\/613\/66339052\/annalsats_18_4_613.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/annalsats\/article-pdf\/18\/4\/613\/66339052\/annalsats_18_4_613.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T08:53:43Z","timestamp":1769072023000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/annalsats\/article\/18\/4\/613\/8419589"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,1]]},"references-count":44,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2021,4,1]]},"published-print":{"date-parts":[[2021,4,1]]}},"URL":"https:\/\/doi.org\/10.1513\/annalsats.202007-774oc","relation":{},"ISSN":["2329-6933","2325-6621"],"issn-type":[{"value":"2329-6933","type":"print"},{"value":"2325-6621","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2021,4]]},"published":{"date-parts":[[2021,4,1]]},"assertion":[{"value":"2020-07-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-10-15","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2021-04-01","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}