Cardiovascular

Electrocardiographic markers of arrhythmogenic risk in methamphetamine and cannabis use disorders.

Kulacaoglu F, Sezgin E, et al. • Psychiatry research • 2026

PubMed 42659754 DOI 10.1016/j.psychres.2026.117411

TL;DR

Methamphetamine use disorder is associated with substantial ventricular repolarization disturbances with JTcd emerging as the most sensitive ECG marker, while cannabis use disorder showed elevated fragmented QRS prevalence suggesting subclinical myocardial structural abnormalities despite normal repolarization parameters.

Key Findings

Results

The MUD group demonstrated significantly prolonged QTc, QTcd, and JTcd values compared to both CUD and HC groups.

All comparisons reached statistical significance at p < 0.001
Study included 63 patients with MUD, 63 with CUD, and 63 age-matched male healthy controls
Standard 12-lead ECGs were obtained within the first hour of admission
This was a retrospective cross-sectional study conducted at a substance addiction treatment center

Results

JTcd was identified as the most discriminative ECG parameter for distinguishing methamphetamine use disorder from controls.

ROC analysis identified JTcd with AUC = 0.718
JTcd outperformed QTc (AUC = 0.682) and QTcd (AUC = 0.676)
JTcd represents JT dispersion, a marker of ventricular repolarization heterogeneity
These findings suggest JTcd is the most sensitive ECG marker for methamphetamine-associated repolarization disturbances

Results

Heart rate was significantly elevated in the MUD group compared to the CUD group.

The difference in heart rate between MUD and CUD groups was statistically significant (p = 0.008)
Heart rate was among the ECG parameters assessed alongside QTc, QTcd, JTc, JTcd, Tp-e interval, Tp-e/QTc ratio, P-wave dispersion, frontal QRS-T angle, frontal QRS axis, and fragmented QRS

Results

Cannabis users showed no significant differences in repolarization parameters compared to healthy controls.

Parameters assessed included QTc, QTcd, JTc, JTcd, Tp-e interval, Tp-e/QTc ratio, P-wave dispersion, and frontal QRS-T angle
The CUD group did not differ significantly from HC on any repolarization measure
This finding suggests cannabis use disorder does not produce measurable ventricular repolarization disturbances detectable on standard ECG

Results

Fragmented QRS (fQRS) prevalence was significantly elevated in both CUD and MUD groups relative to healthy controls.

fQRS prevalence was 14.3% in the CUD group and 17.5% in the MUD group, compared to 1.6% in healthy controls
The difference was statistically significant (p = 0.011)
Elevated fQRS is interpreted as suggesting subclinical myocardial structural abnormalities in both substance use disorder groups
fQRS was elevated in cannabis users despite the absence of repolarization parameter differences

Conclusions

The study authors concluded that routine ECG assessment is warranted in patients with substance use disorders.

Findings indicate methamphetamine use is associated with substantial ventricular repolarization disturbances
Cannabis use disorder showed potential subclinical myocardial injury evidenced by elevated fQRS despite normal repolarization parameters
The study sample was restricted to male patients, which may limit generalizability
Retrospective cross-sectional design was used, and ECGs were obtained within the first hour of admission

What This Means

This research suggests that using methamphetamine or cannabis can produce measurable changes in the electrical activity of the heart, as seen on electrocardiograms (ECGs). The study compared heart electrical readings from 63 methamphetamine users, 63 cannabis users, and 63 healthy men who served as controls. Methamphetamine users showed notable abnormalities in how the heart's ventricles (lower chambers) recover electrically after each beat — a process called repolarization. These abnormalities, particularly a measure called JT dispersion (JTcd), were the best indicators of methamphetamine use and are associated with increased risk of dangerous heart rhythm problems (arrhythmias). Cannabis users did not show the same repolarization abnormalities as methamphetamine users, but both groups had elevated rates of a finding called fragmented QRS (fQRS) — 14.3% in cannabis users and 17.5% in methamphetamine users, compared to just 1.6% in healthy controls. This research suggests that fQRS may reflect subtle, underlying structural damage to the heart muscle in people who use these substances, even when other ECG measures appear normal. These findings matter because they highlight that both methamphetamine and cannabis use may have hidden effects on the heart that are not always obvious clinically. The authors suggest that routine ECG screening could be valuable when people with substance use disorders are admitted for treatment, allowing clinicians to identify those at higher cardiac risk. The study was limited to male patients at a single treatment center and used a retrospective design, so further research in broader populations would be needed to confirm these findings.

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Citation

Kulacaoglu F, Sezgin E, Gumusay M, Yildirim Y, Sert S. (2026). Electrocardiographic markers of arrhythmogenic risk in methamphetamine and cannabis use disorders.. Psychiatry research. https://doi.org/10.1016/j.psychres.2026.117411

Key Findings

What This Means

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