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Wang J, Yang ZG, Fang H, Yan WF, Shen MT, Guo YK, Jiang L, Jiang Y, Min CY, Li Y. Biventricular Impairment and Ventricular Interdependence in Patients With Alcoholic Cardiomyopathy: Insights Through Cardiac Magnetic Resonance Imaging. J Magn Reson Imaging 2024. [PMID: 38558213 DOI: 10.1002/jmri.29350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Revised: 03/02/2024] [Accepted: 03/04/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Alcoholic cardiomyopathy (ACM) can lead to progressive cardiac dysfunction and heart failure, but little is known about biventricular impairment and ventricular interdependence (VI) in ACM patients. PURPOSE To use cardiac MRI to investigate biventricular impairment and VI in ACM patients. STUDY TYPE Retrospective. POPULATION Forty-one male patients with ACM and 45 sex- and age-matched controls. FIELD STRENGTH/SEQUENCE 3.0 T/balanced steady-state free precession sequence, inversion recovery prepared echo-planar imaging sequence and phase-sensitive inversion recovery sequence. ASSESSMENT Biventricular structure, function, and global strain (encompassing peak strain [PS], peak systolic, and diastolic strain rate), PS of interventricular septal (IVS), microvascular perfusion (including upslope and time to maximum signal intensity [TTM]), late gadolinium enhancement (LGE), and baseline characteristics were compared between the controls and ACM patients. STATISTICAL TESTS Student's t-test, Mann-Whitney U test, Pearson's correlation, and multivariable linear regression models with a stepwise selection procedure. A two-tailed P value <0.05 was deemed as statistically significant. RESULTS Compared to control subjects, ACM patients showed significantly biventricular adverse remodeling, reduced left ventricle (LV) global upslope and prolonged global TTM, and the presence of LGE. ACM patients were characterized by a significant decline in all global strain within the LV, right ventricle (RV), and IVS compared with the controls. RV global PS was significantly associated with LV global PS and IVS PS in radial, circumferential, and longitudinal directions. Multivariable analyses demonstrated the longitudinal PS of IVS was significantly correlated with RV global radial PS (β = 0.614) and circumferential PS (β = 0.545). Additionally, RV global longitudinal PS (GLPS) was significantly associated with radial PS of IVS (β = -0.631) and LV GLPS (β = 1.096). DATA CONCLUSION ACM patients exhibited biventricular adverse structural alterations and impaired systolic and diastolic function. This cohort also showed reduced LV microvascular perfusion, the presence of LGE, and unfavorable VI. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Jin Wang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Han Fang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wei-Feng Yan
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Meng-Ting Shen
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Ying-Kun Guo
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li Jiang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yu Jiang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chen-Yan Min
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuan Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Simon J, Fung K, Kolossváry M, Sanghvi MM, Aung N, Paiva JM, Lukaschuk E, Carapella V, Merkely B, Bittencourt MS, Karády J, Lee AM, Piechnik SK, Neubauer S, Maurovich-Horvat P, Petersen SE. Sex-specific associations between alcohol consumption, cardiac morphology, and function as assessed by magnetic resonance imaging: insights form the UK Biobank Population Study. Eur Heart J Cardiovasc Imaging 2021; 22:1009-1016. [PMID: 33313691 PMCID: PMC7613253 DOI: 10.1093/ehjci/jeaa242] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 08/03/2020] [Indexed: 12/19/2022] Open
Abstract
AIMS Data regarding the effects of regular alcohol consumption on cardiac anatomy and function are scarce. Therefore, we sought to determine the relationship between regular alcohol intake and cardiac structure and function as evaluated with cardiac magnetic resonance imaging. METHODS AND RESULTS Participants of the UK Biobank who underwent cardiac magnetic resonance were enrolled in our analysis. Data regarding regular alcohol consumption were obtained from questionnaires filled in by the study participants. Exclusion criteria were poor image quality, missing, or incongruent data regarding alcohol drinking habits, prior drinking, presence of heart failure or angina, and prior myocardial infarction or stroke. Overall, 4335 participants (61.5 ± 7.5 years, 47.6% male) were analysed. We used multivariate linear regression models adjusted for age, ethnicity, body mass index, smoking, hypertension, diabetes mellitus, physical activity, cholesterol level, and Townsend deprivation index to examine the relationship between regular alcohol intake and cardiac structure and function. In men, alcohol intake was independently associated with marginally increased left ventricular end-diastolic volume [β = 0.14; 95% confidence interval (CI) = 0.05-0.24; P = 0.004], left ventricular stroke volume (β = 0.08; 95% CI = 0.03-0.14; P = 0.005), and right ventricular stroke volume (β = 0.08; 95% CI = 0.02-0.13; P = 0.006). In women, alcohol consumption was associated with increased left atrium volume (β = 0.14; 95% CI = 0.04-0.23; P = 0.006). CONCLUSION Alcohol consumption is independently associated with a marginal increase in left and right ventricular volumes in men, but not in women, whereas alcohol intake showed an association with increased left atrium volume in women. Our results suggest that there is only minimal relationship between regular alcohol consumption and cardiac morphology and function in an asymptomatic middle-aged population.
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Affiliation(s)
- Judit Simon
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Kenneth Fung
- William Harvey Research Institute, NIHR Biomedical Research Centre at Barts, Queen Mary University of London, London, United Kingdom
| | - Márton Kolossváry
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Mihir M. Sanghvi
- William Harvey Research Institute, NIHR Biomedical Research Centre at Barts, Queen Mary University of London, London, United Kingdom
| | - Nay Aung
- William Harvey Research Institute, NIHR Biomedical Research Centre at Barts, Queen Mary University of London, London, United Kingdom
| | - Jose Miguel Paiva
- William Harvey Research Institute, NIHR Biomedical Research Centre at Barts, Queen Mary University of London, London, United Kingdom
| | - Elena Lukaschuk
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | | | - Béla Merkely
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | | | - Júlia Karády
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Cardiac MR PET CT Program, Massachusetts General Hospital – Harvard Medical School, Boston, USA
| | - Aaron M Lee
- William Harvey Research Institute, NIHR Biomedical Research Centre at Barts, Queen Mary University of London, London, United Kingdom
| | - Stefan K. Piechnik
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, United Kingdom
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Medical Imaging Centre, Semmelweis University, Budapest, Hungary
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Biomedical Research Centre at Barts, Queen Mary University of London, London, United Kingdom
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3
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Silva AF, Sousa-Nunes F, Faria-Costa G, Rodrigues I, Guimarães JT, Leite-Moreira A, Henriques-Coelho T, Negrão R, Moreira-Gonçalves D. Effects of chronic moderate alcohol consumption on right ventricle and pulmonary remodelling. Exp Physiol 2021; 106:1359-1372. [PMID: 33605491 DOI: 10.1113/ep088788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 02/12/2021] [Indexed: 11/08/2022]
Abstract
NEW FINDINGS What is the central question of this study? Does the consumption of a moderate amount of alcohol differentially impact the heart ventricles and pulmonary vasculature. What is the main finding and its importance? Moderate alcohol consumption for a short period of time impaired pulmonary vascular cellular renewal through an apoptosis resistance pattern that ultimately affected the right ventricular function and structure. These findings support the need for a deeper understanding of effects of moderate alcohol consumption on the overall cardiovascular and pulmonary systems. ABSTRACT Over the past decades, observational studies have supported an association between moderate alcohol consumption and a lower risk of cardiovascular disease and mortality. However, recent and more robust meta-analyses have raised concerns around the robustness of the evidence for the cardioprotective effects of alcohol. Also, studies of the functional, structural and molecular changes promoted by alcohol have focused primarily on the left ventricle, ignoring the fact that the right ventricle could adapt differently. The aim of this study was to evaluate the bi-ventricular impact of daily moderate alcohol intake, during a 4-week period, in a rodent model. Male Wistar rats were allowed to drink water (Control) or a 5.2% ethanol mixture (ETOH) for 4 weeks. At the end of the protocol bi-ventricular haemodynamic recordings were performed and samples collected for further histological and molecular analysis. ETOH ingestion did not impact cardiac function. However, it caused right ventricle hypertrophy, paralleled by an activation of molecular pathways responsible for cell growth (ERK1/2, AKT), proteolysis (MURF-1) and oxidative stress (NOX4, SOD2). Furthermore, ETOH animals also presented remodelling of the pulmonary vasculature with an increase in pulmonary arteries' medial thickness, which was characterized by increased expression of apoptosis-related proteins expression (BCL-XL, BAX and caspases). Moderate alcohol consumption for a short period of time impaired the lungs and the right ventricle early, before any change could be detected on the left ventricle. Right ventricular changes might be secondary to alcohol-induced pulmonary vasculature remodelling.
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Affiliation(s)
- Ana Filipa Silva
- Unidade de Investigação Cardiovascular, Faculdade de Medicina da Universidade do Porto, Al. Professor Hernâni Monteiro, Porto, Portugal.,Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Al. Professor Hernâni Monteiro, Porto, Portugal
| | - Fábio Sousa-Nunes
- Unidade de Investigação Cardiovascular, Faculdade de Medicina da Universidade do Porto, Al. Professor Hernâni Monteiro, Porto, Portugal.,Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Al. Professor Hernâni Monteiro, Porto, Portugal
| | - Gabriel Faria-Costa
- Unidade de Investigação Cardiovascular, Faculdade de Medicina da Universidade do Porto, Al. Professor Hernâni Monteiro, Porto, Portugal.,Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Al. Professor Hernâni Monteiro, Porto, Portugal
| | - Ilda Rodrigues
- Departamento de Biomedicina - Unidade de Bioquímica, Faculdade de Medicina da Universidade do Porto, Al. Professor Hernâni Monteiro, Porto, Portugal
| | - João Tiago Guimarães
- Departamento de Biomedicina - Unidade de Bioquímica, Faculdade de Medicina da Universidade do Porto, Al. Professor Hernâni Monteiro, Porto, Portugal.,Departamento de Patologia Clínica, Centro Hospitalar Universitário São João, Al. Professor Hernâni Monteiro, Porto, Portugal.,Instituto de Saúde Pública da Universidade do Porto, Campo dos Mártires da Pátria, Porto, Portugal
| | - Adelino Leite-Moreira
- Unidade de Investigação Cardiovascular, Faculdade de Medicina da Universidade do Porto, Al. Professor Hernâni Monteiro, Porto, Portugal.,Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Al. Professor Hernâni Monteiro, Porto, Portugal
| | - Tiago Henriques-Coelho
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Al. Professor Hernâni Monteiro, Porto, Portugal
| | - Rita Negrão
- Departamento de Biomedicina - Unidade de Bioquímica, Faculdade de Medicina da Universidade do Porto, Al. Professor Hernâni Monteiro, Porto, Portugal.,I3S, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, R. Alfredo Allen, Porto, Portugal
| | - Daniel Moreira-Gonçalves
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina da Universidade do Porto, Al. Professor Hernâni Monteiro, Porto, Portugal.,Centro de Atividade Física, Saúde e Lazer, Faculdade de Desporto da Universidade do Porto, R. Plácido Costa 91, Porto, Portugal
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Gonçalves A, Jhund PS, Claggett B, Shah AM, Konety S, Butler K, Kitzman DW, Rosamond W, Fuchs FD, Solomon SD. Relationship between alcohol consumption and cardiac structure and function in the elderly: the Atherosclerosis Risk In Communities Study. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.114.002846. [PMID: 26015266 DOI: 10.1161/circimaging.114.002846] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Excessive alcohol consumption is associated with cardiomyopathy, but the influence of moderate alcohol use on cardiac structure and function is largely unknown. METHODS AND RESULTS We studied 4466 participants from visit 5 of the Atherosclerosis Risk in Communities (ARIC) study (76±5 years and 60% women) who underwent transthoracic echocardiography, excluding former drinkers and those with significant valvular disease. Participants were classified into 4 categories based on self-reported alcohol intake: nondrinkers, drinkers of ≤7, ≥7 to 14, and ≥14 drinks per week. We related alcohol intake to measures of cardiac structure and function, stratified by sex, and fully adjusted for covariates. In both genders, increasing alcohol intake was associated with larger left ventricular diastolic and systolic diameters and larger left atrial diameter (P<0.05). In men, increasing alcohol intake was associated with greater left ventricular mass (8.2±3.8 g per consumption category; P=0.029) and higher E/E' ratio (0.82±0.33 per consumption category; P=0.014). In women, increasing alcohol intake was associated with lower left ventricular ejection fraction (-1.9±0.6% per consumption category; P=0.002) and a tendency for worse left ventricular global longitudinal strain (0.45±0.25% per consumption category; P=0.07). CONCLUSIONS In an elderly community-based population, increasing alcohol intake is associated with subtle alterations in cardiac structure and function, with women appearing more susceptible than men to the cardiotoxic effects of alcohol.
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Affiliation(s)
- Alexandra Gonçalves
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.G., P.S.J., B.C., A.M.S., S.D.S.); University of Porto Medical School, Porto, Portugal (A.G.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.S.J.); Cardiovascular Division, University of Minnesota Medical School, Minneapolis (S.K.); Department of Medicine, University of Mississippi Medical Centre, Jackson (K.B.); Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (W.R.); and Division of Cardiology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil (F.D.F.)
| | - Pardeep S Jhund
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.G., P.S.J., B.C., A.M.S., S.D.S.); University of Porto Medical School, Porto, Portugal (A.G.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.S.J.); Cardiovascular Division, University of Minnesota Medical School, Minneapolis (S.K.); Department of Medicine, University of Mississippi Medical Centre, Jackson (K.B.); Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (W.R.); and Division of Cardiology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil (F.D.F.)
| | - Brian Claggett
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.G., P.S.J., B.C., A.M.S., S.D.S.); University of Porto Medical School, Porto, Portugal (A.G.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.S.J.); Cardiovascular Division, University of Minnesota Medical School, Minneapolis (S.K.); Department of Medicine, University of Mississippi Medical Centre, Jackson (K.B.); Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (W.R.); and Division of Cardiology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil (F.D.F.)
| | - Amil M Shah
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.G., P.S.J., B.C., A.M.S., S.D.S.); University of Porto Medical School, Porto, Portugal (A.G.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.S.J.); Cardiovascular Division, University of Minnesota Medical School, Minneapolis (S.K.); Department of Medicine, University of Mississippi Medical Centre, Jackson (K.B.); Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (W.R.); and Division of Cardiology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil (F.D.F.)
| | - Suma Konety
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.G., P.S.J., B.C., A.M.S., S.D.S.); University of Porto Medical School, Porto, Portugal (A.G.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.S.J.); Cardiovascular Division, University of Minnesota Medical School, Minneapolis (S.K.); Department of Medicine, University of Mississippi Medical Centre, Jackson (K.B.); Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (W.R.); and Division of Cardiology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil (F.D.F.)
| | - Kenneth Butler
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.G., P.S.J., B.C., A.M.S., S.D.S.); University of Porto Medical School, Porto, Portugal (A.G.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.S.J.); Cardiovascular Division, University of Minnesota Medical School, Minneapolis (S.K.); Department of Medicine, University of Mississippi Medical Centre, Jackson (K.B.); Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (W.R.); and Division of Cardiology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil (F.D.F.)
| | - Dalane W Kitzman
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.G., P.S.J., B.C., A.M.S., S.D.S.); University of Porto Medical School, Porto, Portugal (A.G.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.S.J.); Cardiovascular Division, University of Minnesota Medical School, Minneapolis (S.K.); Department of Medicine, University of Mississippi Medical Centre, Jackson (K.B.); Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (W.R.); and Division of Cardiology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil (F.D.F.)
| | - Wayne Rosamond
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.G., P.S.J., B.C., A.M.S., S.D.S.); University of Porto Medical School, Porto, Portugal (A.G.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.S.J.); Cardiovascular Division, University of Minnesota Medical School, Minneapolis (S.K.); Department of Medicine, University of Mississippi Medical Centre, Jackson (K.B.); Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (W.R.); and Division of Cardiology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil (F.D.F.)
| | - Flavio D Fuchs
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.G., P.S.J., B.C., A.M.S., S.D.S.); University of Porto Medical School, Porto, Portugal (A.G.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.S.J.); Cardiovascular Division, University of Minnesota Medical School, Minneapolis (S.K.); Department of Medicine, University of Mississippi Medical Centre, Jackson (K.B.); Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (W.R.); and Division of Cardiology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil (F.D.F.)
| | - Scott D Solomon
- From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.G., P.S.J., B.C., A.M.S., S.D.S.); University of Porto Medical School, Porto, Portugal (A.G.); Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom (P.S.J.); Cardiovascular Division, University of Minnesota Medical School, Minneapolis (S.K.); Department of Medicine, University of Mississippi Medical Centre, Jackson (K.B.); Department of Cardiology, Wake Forest School of Medicine, Winston-Salem, NC (D.W.K.); Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill (W.R.); and Division of Cardiology, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil (F.D.F.).
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Naik B, Matsumoto AH. Acute cor pulmonale and right heat failure complicating ethanol ablative therapy: anesthetic and radiologic considerations and management. Cardiovasc Intervent Radiol 2013; 36:1213-20. [PMID: 23377237 DOI: 10.1007/s00270-013-0549-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 12/13/2012] [Indexed: 11/28/2022]
Abstract
Ethanol is an effective ablative agent used for the treatment of certain solid organ tumors and vascular malformations (VMs). The egress of ethanol beyond the target tissue can be associated with significant changes to the cardiopulmonary system that can lead to cardiac arrest. This article reviews the contemporary role of ethanol in tumor and VM treatment and discusses the physiological mechanisms of acute pulmonary hypertension and cardiovascular collapse. The importance of periprocedural recognition of the hemodynamic changes that can occur with the use of ethanol and the treatment of this condition are discussed.
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Affiliation(s)
- Bhiken Naik
- Department of Anesthesiology, University of Virginia, PO Box 800710, Charlottesville, VA, 22008-0710, USA,
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Cameli M, Ballo P, Garzia A, Lisi M, Bocelli A, Mondillo S. Acute effects of low doses of ethanol on left and right ventricular function in young healthy subjects. Alcohol Clin Exp Res 2011; 35:1860-5. [PMID: 21762179 DOI: 10.1111/j.1530-0277.2011.01530.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Moderate-to-high blood concentrations of ethanol acutely impair conventional echocardiographic measures of left ventricular (LV) performance, but the effects of low concentrations are unclear. This study explored the acute effects of low blood concentrations of ethanol on sensitive and load-independent indices of LV and right ventricular (RV) function. METHODS This is a crossover experimental study conducted in 64 young healthy volunteers. Participants were asked to drink a light dose of Italian red wine equivalent to 0.5 mg/kg of ethanol, and an equal volume of fruit juice in separate experiments. The following measurements were taken at baseline and 60 minutes after the challenges: tissue Doppler mitral annulus systolic velocity (S') and excursion (MAPSE), early diastolic velocity (E'), its ratio to late diastolic velocity (E'/A'), and the ratio of mitral-to-myocardial early diastolic velocities (E/E'); and tricuspid annulus systolic velocity (tricuspid S') and amplitude (TAPSE), early diastolic velocity (tricuspid E'), and its ratio to late diastolic velocity (tricuspid E'/A'). RESULTS Blood ethanol concentration after wine intake was 0.48 ± 0.06 g/l. Compared with the control challenge, ethanol yielded a decrease in all measures of LV function (S', -9.7%; E', -11.2%; E'/A', -13.4%; MAPSE, -8.8%; p < 0.05 for all). Among indices of RV function, increases in tricuspid E'/A' ratio and TAPSE were observed (+24.5% and +9.0%, respectively; p < 0.05 for both). CONCLUSIONS Low blood concentrations of ethanol acutely impair LV function and increase some indices of RV function in young healthy individuals.
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Affiliation(s)
- Matteo Cameli
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy.
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Fracasso T, Pfeiffer H, Köhler H, Wieseler S, Hansen SD, Jentgens L, Sauerland C, Schmeling A. Immunohistochemical expression of fibronectin and C5b-9 in the myocardium in cases of fatal ethanol intoxication. Int J Legal Med 2011; 125:537-42. [PMID: 21234582 DOI: 10.1007/s00414-011-0547-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Accepted: 01/03/2011] [Indexed: 11/27/2022]
Abstract
Data from the literature indicate that the pulmonary pressure rises in cases of ethanol intake. We have recently proposed a method for the detection of prevalent right ventricular damage in cases of fatal pulmonary thromboembolism and pulmonary fat embolism. In the present study, we compared the expression of the antibodies against fibronectin and C5b-9 in 19 cases of lethal alcohol intoxications (study group: 5 females, 14 males, mean age 46 years, mean blood ethanol concentration 3.5‰, min. 2.11‰, max. 5.31‰) to a group of 26 cases of fatal pulmonary thromboembolism (PE; group 2: 16 females, 10 males, mean age 56 years). Moreover, a group of 15 cases of hanging (group 3: 5 females, 10 males, mean age 50 years) as well as a group of 18 cases of myocardial infarction (group 4: 5 females, 13 males, mean age 61 years) were investigated as examples of typical cardiac damage due to global hypoxia during agony and ischemic damage, respectively. The results of this study show that fresh cardiac damage can be detected at both ventricles in cases of fatal ethanol intoxication with the antibody against fibronectin. The damage is prevalently localised at the right ventricle (RV), as already observed in cases of acute pulmonary hypertension determining right heart failure. The degree of damage at the RV in cases of ethanol intoxications is lower than the one observed in cases of fatal PE.
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Affiliation(s)
- Tony Fracasso
- Institute of Legal Medicine, University Hospital Münster, Röntgenstr. 23, 48149 Münster, Germany.
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Agrawal S, Payal YS, Burathoki S, Asthana V, Rizvi A, Sharma JP. Case study: Systemic complications following absolute alcohol embolisation of scalp arteriovenous malformation. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2010. [DOI: 10.1080/22201173.2010.10872669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Procedure-related pulmonary hypertension in patients with hepatocellular carcinoma undergoing percutaneous ethanol injection—Role of ethanol, hemolysis, asymmetric dimethylarginine, and the nitric oxide system. Crit Care Med 2009; 37:1483-5. [DOI: 10.1097/ccm.0b013e31819c3a10] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Ko JS, Kim JA, Do YS, Kwon MA, Choi SJ, Gwak MS, Lee JJ, Yang M. Prediction of the effect of injected ethanol on pulmonary arterial pressure during sclerotherapy of arteriovenous malformations: relationship with dose of ethanol. J Vasc Interv Radiol 2008; 20:39-45; quiz 45. [PMID: 19028113 DOI: 10.1016/j.jvir.2008.10.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2008] [Revised: 10/03/2008] [Accepted: 10/14/2008] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To prospectively evaluate the effect of injected ethanol on pulmonary artery pressure during embolosclerotherapy of arteriovenous malformations (AVMs). MATERIALS AND METHODS This prospective study was conducted in 16 male and 14 female patients (37 sessions; mean age, 34 years; age range, 17-67 years) with AVMs during a 2-year period. The authors measured pulmonary artery pressure via a pulmonary artery catheter and ethanol levels from the pulmonary and radial arteries simultaneously within 3 minutes after each ethanol injection. The authors analyzed the relationship between pulmonary artery pressure and ethanol levels obtained from pulmonary and radial arteries with respect to both single and cumulative doses of ethanol injected. Retrospectively, patients were divided into two groups-those treated with and those treated without vascular occlusion techniques. RESULTS The radial arterial ethanol level showed good correlation with the pulmonary arterial ethanol level (r = 0.7). Single dose per injection was statistically related with pulmonary artery pressure (r = 0.5 vs 0.1 and P < .05 vs .29, respectively, in patients treated without and patients treated with vascular occlusion techniques), and the correlation coefficient between cumulative dose and pulmonary artery pressure was 0.2 and 0.3 in respective cases (P < .05 for both). The mean pulmonary artery pressure correlated with pulmonary arterial ethanol level irrespective of the use of vascular occlusion (r = 0.6 for both groups). CONCLUSIONS Pulmonary artery pressure reflected the pulmonary arterial ethanol level and was positively related to the dose of ethanol. Single dose per injection was predictive of pulmonary artery pressure only in patients treated without vascular occlusion techniques.
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Affiliation(s)
- Justin S Ko
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University, School of Medicine, Seoul, Korea
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Sidi A, Naik B, Muehlschlegel J, Kirby D, Lobato E. Ethanol-induced acute pulmonary hypertension and right ventricular dysfunction in pigs. Br J Anaesth 2008; 100:568-9. [DOI: 10.1093/bja/aen047] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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El-Mas MM, Abdel-Rahman AA. Role of Myocardial Contractility and Autonomic Control in the Hypotensive Response to a Limited Access Ethanol Paradigm in SHRs. Alcohol Clin Exp Res 2007; 31:1071-9. [PMID: 17428291 DOI: 10.1111/j.1530-0277.2007.00395.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND Previous experimental studies that evaluated the chronic hemodynamic effect of ethanol employed the continuous exposure protocol of ethanol, which does not mimic the pattern of alcohol consumption in humans. This study dealt with the long-term hemodynamic and cardiovascular autonomic effects of ethanol, in a limited-access regimen in telemetered spontaneously hypertensive rats (SHRs). METHODS Changes in blood pressure (BP), heart rate (HR), myocardial contractility (dP/dt(max)), and spectral cardiovascular autonomic profiles during the ethanol exposure period (2.5 or 5% w/v, 8 h/d, 8:30 am till 4:30 pm) were followed for 12 weeks. RESULTS Compared with control pair-fed SHRs, body weight and urine output, osmolality, and potassium levels were decreased in SHRs receiving 5% but not 2.5% ethanol. Blood pressure showed progressive falls during ethanol-feeding periods with a maximum effect observed at week 5. The peak hypotensive effect was maintained thereafter in SHRs receiving 5% ethanol in contrast to steady rises in BP in the 2.5% ethanol group to near-control levels by the conclusion of the study. Heart rate was slightly but significantly increased by ethanol 5% whereas dP/dt(max) showed persistent reductions. Power spectral analysis showed that ethanol attenuated the baroreflex gain of HR as suggested by the reductions in index alpha, the spectral index of spontaneous baroreflex sensitivity (BRS). CONCLUSIONS It is concluded that limited access ethanol drinking in SHRs elicited hypotension that was concentration dependent and mediated, at least partly, through reductions in myocardial contractility. Baroreflex sensitivity attenuation by ethanol appeared to have limited the tachycardic response to ethanol and perhaps its capacity to offset the evoked hypotension.
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Affiliation(s)
- Mahmoud M El-Mas
- Department of Pharmacology, School of Medicine, East Carolina University, Greenville, North Carolina 27834, USA
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Kajander OA, Kupari M, Laippala P, Savolainen V, Pajarinen J, Penttilä A, Karhunen PJ. Dose dependent but non-linear effects of alcohol on the left and right ventricle. Heart 2001; 86:417-23. [PMID: 11559683 PMCID: PMC1729926 DOI: 10.1136/heart.86.4.417] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess how left (LV) and right ventricular (RV) size, wall thickness, and mass depend on daily alcohol consumption. Among alcoholics, most common findings have been LV hypertrophy and mild systolic or diastolic dysfunction, accompanied occasionally by ventricular dilatation resembling dilated cardiomyopathy. Although it is commonly agreed that chronic heavy alcohol use is injurious to the heart, the dose-injury relation remains a matter of dispute. DESIGN Prospective series of 700 Finnish men aged 33-70 years who died out of hospital and underwent a medicolegal necropsy. METHODS AND RESULTS Data on alcohol use and other risk factors were obtained from the spouse. At necropsy, a transversal slice of the heart was traced on a transparent sheet and analysed later for LV and RV cavity areas and wall thicknesses. Coronary artery stenoses were measured from silicone casts of the arteries. In analyses of all men, daily alcohol dose predicted heart weight (beta = 0.17, p < 0.001) and RV cavity area (beta = 0.14, p = 0.007) independent of body size, age, coronary artery disease, hypertension, diabetes, and smoking. In the subgroup of men free of significant coronary artery disease, LV area averaged (SEM) 11.0 (1.0) cm(2) in men drinking < 12 g/day, 7.7 (0.7) cm(2) in those drinking 72-180 g/day, and 10.0 (0.9) cm(2) in those drinking > 180 g/day (p = 0.054). Very heavy drinking (> 180 g/day) was associated with an increase in RV cavity area (p = 0.005). CONCLUSIONS The effects of alcohol on the heart in middle aged men are dose dependent but partly non-linear. In the absence of coronary artery disease, LV size shows a U shaped reduction with increasing daily alcohol use accompanied by an increase in RV size with very heavy drinking. These findings question the idea of progressive LV dilatation with increasing alcohol consumption among male victims of sudden death.
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Affiliation(s)
- O A Kajander
- Medical School, University of Tampere and Tampere University Hospital, Tampere, Finland.
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El-Mas MM, Abdel-Rahman AA. Role of cardiac output in ethanol-evoked attenuation of centrally mediated hypotension in conscious rats. Hypertension 1997; 30:288-94. [PMID: 9260994 DOI: 10.1161/01.hyp.30.2.288] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Our previous studies have shown that ethanol selectively counteracts centrally mediated hypotensive responses. This study investigated the role of cardiac output and peripheral resistance in the antagonistic interaction between ethanol and antihypertensive drugs. Changes in blood pressure, heart rate, cardiac index, stroke volume, and peripheral resistance elicited by clonidine and subsequent ethanol or saline administration were evaluated in conscious rats. The aortic barodenervated rat was employed because it exhibits greater hypotensive responses to clonidine compared with the intact rat. Aortic barodenervation elicited acute rises in blood pressure, heart rate, and peripheral resistance, whereas cardiac index and stroke volume were not altered. The blood pressure of conscious aortic barodenervated rats returned to sham-operated levels by 48 hours due to concomitant reductions in cardiac index and stroke volume; the peripheral resistance, however, remained significantly elevated. Clonidine (30 microg/kg, I.V.) elicited greater decreases in blood pressure in aortic barodenervated compared with sham-operated rats. The hypotension was caused by decreases in cardiac index and stroke volume because peripheral resistance did not change. Ethanol (1 g/kg, I.V.) counteracted the hypotensive effect of clonidine and raised blood pressure to levels higher than preclonidine values. Significant (P<.05) increases in cardiac index and stroke volume and decreases in peripheral resistance accompanied the pressor effect of ethanol. Additional control groups were included in the study to determine the selectivity of the interaction. A dose of hydralazine (0.5 mg/kg, I.V.) was used that produced similar hypotension to that evoked by clonidine in aortic barodenervated rats. Hydralazine-evoked hypotension was similar in denervated and control rats and resulted from significant reductions in peripheral resistance. Reflex increases in heart rate and stroke volume and hence cardiac output were observed. Ethanol given after hydralazine produced a short-lived pressor effect (<5 minutes versus 40 minutes in the case of clonidine) and counteracted the sympathetically mediated increases in cardiac output, stroke volume, and heart rate. These findings support our hypothesis that ethanol selectively counteracts hypotensive responses of central origin by reversing the reduction in cardiac output elicited by clonidine.
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Affiliation(s)
- M M El-Mas
- Department of Pharmacology, School of Medicine, East Carolina University, Greenville, NC 27858, USA
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Kettunen RV, Timisjärvi J, Heikkilä J, Saukko P. The acute dose-dependent effects of ethanol on canine myocardial perfusion. Alcohol 1994; 11:351-4. [PMID: 7818790 DOI: 10.1016/0741-8329(94)90016-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The acute effects of ethanol (1.0 g/kg and 1.5 g/kg, n = 4 and n = 5, yielding blood concentrations of 1.3 +/- 0.2 mg/ml and 2.4 +/- 0.3 mg/ml) on myocardial perfusion were studied in anesthetized, thoracotomized, artificially ventilated dogs by using a radioactive microsphere technique. The control group (n = 5) received saline. The smaller dose of ethanol decreased perfusion in the left ventricular myocardium from 0.737 +/- 0.122 to 0.555 +/- 0.122 ml/g/min (NS), whereas the greater dose nonsignificantly increased it, from 0.744 +/- 0.115 to 0.819 +/- 0.119 ml/g/min (p < 0.01 between the groups). These changes were most evident in subendocardial layers (p < 0.01 both within the groups and between the groups). The greater dose of ethanol increased systemic vascular resistance (p < 0.01 when compared to the control group). The changes in right ventricular myocardium were insignificant. The acute effect of ethanol on coronary blood flow is dose-dependent with small to moderate doses reducing demand for left ventricular flow but with increasing doses evoking not only an increase in demand for flow but also an increase in flow.
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Affiliation(s)
- R V Kettunen
- Department of Physiology, University of Oulu, Finland
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