# Aortic Elasticity and Cardiac Electrophysiological Balance in Opioid Users Receiving Buprenorphine/Naloxone Maintenance Therapy

## TL;DR

This study finds that long-term buprenorphine/naloxone therapy in opioid users is linked to changes in aortic elasticity and mild heart electrical changes, suggesting the need for cardiovascular monitoring.

## Contribution

The study provides new insights into aortic elasticity and cardiac electrophysiological changes in opioid users on buprenorphine/naloxone therapy.

## Key findings

- Opioid users on Suboxone showed higher aortic distensibility and lower aortic stiffness compared to controls.
- Long-term Suboxone use was associated with elevated diastolic and pulmonary artery pressures.
- Therapy duration correlated with mild electrophysiological changes in long-term users.

## Abstract

Background: Opioid dependence treated with buprenorphine/naloxone is associated with increased cardiovascular risk; however, data regarding aortic elasticity and cardiac electrophysiological balance during long-term maintenance therapy remain limited. This study investigated aortic stiffness and distensibility in individuals receiving buprenorphine/naloxone (Suboxone), and examined their associations with echocardiographic and electrocardiographic parameters, including the index of cardiac electrophysiological balance (iCEB and iCEBc). Methods: A retrospective cohort analysis was conducted, including 130 intravenous opioid users receiving Suboxone and 150 age- and sex-matched healthy controls. All participants underwent clinical evaluation, transthoracic echocardiography, resting 12-lead electrocardiography, and 24-h ambulatory blood pressure monitoring. Results: Compared to controls, opioid users demonstrated significantly higher aortic distensibility (median 0.019 vs. 0.015, p < 0.001) and lower aortic stiffness (median 52.31 vs. 64.66, p < 0.001). Patients receiving Suboxone for more than 18 months exhibited higher diastolic blood pressure (p = 0.044), mean arterial pressure (p = 0.046), and pulmonary artery pressure (p = 0.022). Aortic elasticity indices showed strong correlations with blood pressure and echocardiographic parameters. In the overall cohort, Suboxone use duration was not significantly correlated with aortic stiffness or distensibility parameters, while a weak negative correlation was observed with ferritin levels (r = −0.231, p = 0.008). In subgroup analysis of long-term users (>18 months), a moderate positive correlation was observed between therapy duration and iCEB values (r = 0.367, p = 0.001). Conclusions: Chronic buprenorphine/naloxone therapy appears to be associated with changes in aortic elasticity, blood pressure, and mild electrophysiological alterations. These results support the use of non-invasive vascular and electrocardiographic evaluations for cardiovascular risk monitoring and stratification among patients receiving opioid maintenance therapy.