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Cocaine is a highly addictive drug with potentially cardiovascular lethal effects. The real prevalence and features of cocaine cardiotoxicity are unknown as they have been evaluated in selected groups. We aimed to assess this using a comprehensive 3T cardiovascular magnetic resonance (3TCMR) protocol in consecutive cocaine addicts.Methods: Consecutive, non-selected, cocaine abusers first attending a rehabilitation clinic were recruited. Medical history and examination, ECG, blood test and 3TCMR were done. The CMR protocol included TrueFISP cines for measurement of left and right ventricular (LV, RV) dimensions and ejection fraction (EF), STIR sequences, dipyridamole (0.84mg/Kg) myocardial perfusion study with gadolinium-DTPA (0.1mmol/Kg), myocardial late gadolinium enhancement (LGE) and T2WTSE study of the aorta. Images were analyzed by 2 independent observers and compared to those of 60 age and gender-matched healthy controls.Results: 74 cocaine abusers were initially included. One subject had a sudden cardiac death 2 days before 3TCMR and another individual had to be excluded because he was diagnosed of previously unknown hypertrophic cardiomyopathy. Finally, 72 consecutive cocaine abusers were included (10 females, 38±7 yrs, age range 26-53 yrs, 7.8±0.8yrs of addiction). Only 4 patients referred mild cardiovascular symptoms (palpitations during abuse). In a per-group analysis, end-systolic volumes were slightly enlarged (LV: 31±8 vs 24±2 mL/m2, RV: 38±11 vs 28±3mL/m2, all P<0.001) and so was the LV mass index (79±14 vs 69±4g/m2, P< 0.001), while EF was significantly decreased both for the left and the right ventricle (LV: 59±5% vs 68±4%, RV: 54±6% vs 64±6%, all P<0.001). In per-patient analysis, 27 subjects (38%) had LVEF below the lower limit of normal and 18 (25%) had decreased RVEF. 13 patients (18%) showed LV hypertrophy (8 concentric, 5 eccentric) and another 13 (18%) showed concentric remodelling. There were no perfusion defects or necrotic patterns, but 19 patients (26%) showed LGE (6 subepicardial, 9 intramyocardial, 4 inferior ventricular junction). Finally, 7 subjects showed aortic atheroma plaques.Conclusion: 3TCMR detected cardiovascular disease of variable degree in 69% of this cohort of consecutive cocaine abusers. The main findings were decrease in LV and RV EF, increase in LV mass index and presence of myocardial LGE, which in the majority of cases suggested previous myocarditis.