Interaction of chronic cigarette and ethanol use on myocardium

Relation of left ventricular function to habitual alcohol consumption

Left ventricular (LV) dysfunction is a frequent finding in chronic alcoholic subjects. LV function's relation to alcohol use in the general population, where low and moderate consumption predominate, was studied in this work. A random sample of 120 people born in 1954 was invited to participate in the study, and 93 (42 men and 51 women) enrolled. Ethanol use was studied by 2-month daily recording of all alcoholic drinks; smoking and physical activity were quantified likewise, and salt intake by 7-day food records. Subsequently, subjects underwent an LV examination by M-mode echocardiography, and a transmitral flow velocity study by pulsed Doppler ultrasound. The relations of LV measurements to alcohol use were studied by multiple linear regression adjusting for sex, body size, blood pressure, heart rate, smoking, physical activity and dietary salt intake. No subject had clinical heart disease. The average daily ethanol consumption ranged from 0 to 1.2 g/kg of body weight (median 0.2). Statistically significant associations with square-root daily ethanol use were found for LV end-systolic diameter (regression coefficient [b] +/- SE 4.0 +/- 1.5 mm/square root of g/kg; p < 0.01), fractional shortening (b = -3.9 +/- 1.8%/square root of g/kg; p < 0.05), peak early transmitral velocity (b = -8.9 +/- 3.5 cm/s/square root of g/kg; p < 0.05), and peak atrial transmitral velocity (b = -4.9 +/- 1.9 cm/s/square root of g/kg; p < 0.05). No interactions with sex were observed.(ABSTRACT TRUNCATED AT 250 WORDS)

Left ventricular size, mass and function in relation to the duration and quantity of heavy drinking in alcoholics

Left ventricular (LV) hypertrophy and mild dysfunction are frequently observed in alcoholics but little is known about how they relate to the duration and severity of alcohol abuse. LV size, mass and function were studied using echocardiography and systolic time intervals in 78 middle-aged male alcoholics who also gave detailed accounts of the duration of heavy drinking, the quantity of recent ethanol consumption and the duration of abstinence. Compared with 34 healthy nonalcoholics, alcoholics had a higher LV mass index (85 +/- 2 [mean +/- standard error] vs 77 +/- 2 g/m2, p = 0.001), a thicker posterior wall (11 +/- 0.2 vs 10 +/- 0.2 mm, p = 0.02), a longer end-systolic diameter index (18 +/- 0.3 vs 17 +/- 0.3 mm/m2, p = 0.02), and a higher preejection period/ejection time ratio (0.36 +/- 0.01 vs 0.33 +/- 0.01, p = 0.002). In multivariate linear regression models, these abnormalities proved independent of the drinking history, except that posterior wall thickness was weakly related to the duration of heavy drinking (standardized correlation coefficient 0.36, p = 0.01). Univariate analyses suggested that the LV mass index and systolic time interval ratio had, if anything, a curvilinear relation to the total duration of heavy alcohol consumption. It is concluded that the LV hypertrophy and dysfunction found in alcoholics are poorly related to the duration and severity of self-reported alcohol abuse. Together with other data, this suggests that there is no simple linear dose-injury relation in the long-term cardiotoxicity of ethanol. Factors modifying the myocardial effects of ethanol need to be studies more in the future.