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Domínguez F, Adler E, García-Pavía P. Alcoholic cardiomyopathy: an update. Eur Heart J 2024; 45:2294-2305. [PMID: 38848133 PMCID: PMC11231944 DOI: 10.1093/eurheartj/ehae362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 03/15/2024] [Accepted: 05/22/2024] [Indexed: 06/09/2024] Open
Abstract
Alcohol-induced cardiomyopathy (AC) is an acquired form of dilated cardiomyopathy (DCM) caused by prolonged and heavy alcohol intake in the absence of other causes. The amount of alcohol required to produce AC is generally considered as >80 g/day over 5 years, but there is still some controversy regarding this definition. This review on AC focuses on pathogenesis, which involves different mechanisms. Firstly, the direct toxic effect of ethanol promotes oxidative stress in the myocardium and activation of the renin-angiotensin system. Moreover, acetaldehyde, the best-studied metabolite of alcohol, can contribute to myocardial damage impairing actin-myosin interaction and producing mitochondrial dysfunction. Genetic factors are also involved in the pathogenesis of AC, with DCM-causing genetic variants in patients with AC, especially titin-truncating variants. These findings support a double-hit hypothesis in AC, combining genetics and environmental factors. The synergistic effect of alcohol with concomitant conditions such as hypertension or liver cirrhosis can be another contributing factor leading to AC. There are no specific cardiac signs and symptoms in AC as compared with other forms of DCM. However, natural history of AC differs from DCM and relies directly on alcohol withdrawal, as left ventricular ejection fraction recovery in abstainers is associated with an excellent prognosis. Thus, abstinence from alcohol is the most crucial step in treating AC, and specific therapies are available for this purpose. Otherwise, AC should be treated according to current guidelines of heart failure with reduced ejection fraction. Targeted therapies based on AC pathogenesis are currently being developed and could potentially improve AC treatment in the future.
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Affiliation(s)
- Fernando Domínguez
- Department of Cardiology, Heart Failure and Inherited Cardiac Diseases Unit, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, CIBERCV, Manuel de Falla, 2, Majadahonda, Madrid 28222, Spain
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Calle de Melchor Fernández Almagro, 3, Madrid, Spain
| | - Eric Adler
- Section Head of Heart Failure, University of California, San Diego, CA, USA
| | - Pablo García-Pavía
- Department of Cardiology, Heart Failure and Inherited Cardiac Diseases Unit, Hospital Universitario Puerta de Hierro Majadahonda, IDIPHISA, CIBERCV, Manuel de Falla, 2, Majadahonda, Madrid 28222, Spain
- Centro Nacional de Investigaciones Cardiovasculares Carlos III, Calle de Melchor Fernández Almagro, 3, Madrid, Spain
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2
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Meng Y, Hu Z, Zhang C, Bai H, Li Z, Guo X, Chen L. miR-92a-3p regulates ethanol-induced apoptosis in H9c2 cardiomyocytes. Cell Stress Chaperones 2024; 29:381-391. [PMID: 38582327 PMCID: PMC11035041 DOI: 10.1016/j.cstres.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Revised: 03/02/2024] [Accepted: 03/25/2024] [Indexed: 04/08/2024] Open
Abstract
The role of miR-92a-3p in the ethanol-induced apoptosis of H9c2 cardiomyocytes remains unclear. In this study, we explored the role of miR-92a-3p in the ethanol-induced apoptosis of H9c2 cardiomyocytes and identified its target genes and signaling pathways. H9c2 cells were cultured with or without 100 mM ethanol for 24 h. The differential expression of miR-92a-3p was verified in H9c2 cells through reverse transcription-quantitative polymerase chain reaction (RT-qPCR). To manipulate the expression of miR-92a-3p, both a mimic and an inhibitor were transfected into H9c2 cells. An Annexin V-fluorescein isothiocyanate/propidium iodide apoptosis detection kit and apoptosis-related antibodies were used for apoptosis detection through flow cytometry and Western blotting, respectively. Target genes were verified through RT-qPCR, Western blotting, and double luciferase reporter gene assays. miR-92a-3p was significantly overexpressed in ethanol-stimulated H9c2 cardiomyocytes (P < 0.001). After ethanol stimulation, H9c2 myocardial cells exhibited increased apoptosis. The apoptosis rate was higher in the miR-92a-3p mimic group than in the control group. However, the apoptosis rate was lower in the miR-92a-3p inhibitor group than in the control group, indicating that miR-92a-3p promotes the ethanol-induced apoptosis of H9c2 myocardial cells. RT-qPCR and Western blotting revealed that the miR-92a-3p mimic and inhibitor significantly regulated the mRNA and protein expression levels of mitogen- and stress-activated protein kinase 2 and cyclic AMP-responsive element-binding protein 3-like protein 2 (CREB3L2), suggesting that miR-92a-3p promotes the apoptosis of H9c2 cardiomyocytes by inhibiting the MSK2/CREB/Bcl-2 pathway. Therefore, the apoptosis of H9c2 cardiomyocytes increases after ethanol stimulation, and miR-92a-3p can directly target MSK2 and CREB3L2, thereby promoting the ethanol-induced apoptosis of H9c2 myocardial cells.
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Affiliation(s)
- Yan Meng
- Department of Nutrition, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Zhenzhen Hu
- Department of Toxicology and Nutrition, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China; Department of Nutrition, Qilu Hospital of Shandong University, Jinan, China
| | - Chenyi Zhang
- Department of Toxicology and Nutrition, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China; Department of Nutrition, Qilu Hospital of Shandong University, Jinan, China
| | - Hao Bai
- Department of Nutrition, Qilu Hospital of Shandong University, Jinan, China
| | - Zhaoping Li
- Department of Nutrition, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Xinru Guo
- Department of Toxicology and Nutrition, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China; Department of Nutrition, Qilu Hospital of Shandong University, Jinan, China
| | - Liyong Chen
- Department of Toxicology and Nutrition, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China; Department of Nutrition, Qilu Hospital of Shandong University, Jinan, China.
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Raja A, Raja S, Amin SB, Ahmed M, Rizvi SHA, Abdalla AS, Majid M, Asghar MS. Trends in substance-induced cardiomyopathy-related mortality among older adults in the United States from 1999 to 2020. Curr Probl Cardiol 2024; 49:102355. [PMID: 38128635 DOI: 10.1016/j.cpcardiol.2023.102355] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 12/23/2023]
Abstract
In this retrospective study, spanning from 1999 to 2020, we examined mortality trends related to SICM (substance-induced cardiomyopathy) among individuals aged 75 and older. A total of 473,408 SICM-related deaths were identified, with detailed data on the place of death available for 454,632 cases, revealing that a significant proportion occurred in medical facilities (45.43 %), nursing homes (24.67 %), hospices (4.21 %), and at home (25.69 %). Our analysis of age-adjusted mortality rates (AAMR) showed an overall decline from 1999 to 2020, decreasing from 14.5 to 7.7 per 10,000 population, with an initial increase from 1999 to 2001 followed by a subsequent decline. Gender-based analysis indicated consistently higher AAMRs for elderly men compared to elderly women. Moreover, we observed variations in AAMRs based on race and ethnicity, with NH Black or African American individuals having the highest AAMRs. Geographic disparities were notable, with states like Delaware having AAMRs twice as high as Utah. The Southern region consistently exhibited the highest AAMR, followed by the Midwestern, Northeastern, and Western regions. Furthermore, metropolitan areas consistently had higher AAMRs than nonmetropolitan areas, although both showed declining trends over the study period. These findings provide valuable insights into SICM-related mortality patterns among the elderly population, emphasizing the importance of considering demographic and geographic factors in public health planning and interventions.
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Affiliation(s)
- Adarsh Raja
- Department of Cardiology, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan.
| | - Sandesh Raja
- Department of Cardiology, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | - Shafin Bin Amin
- Department of Cardiology, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan
| | - Muhammad Ahmed
- Department of Cardiology, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan
| | - Syed Hassan Ahmed Rizvi
- Department of Cardiology, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Muhammad Majid
- Department of Internal Medicine, AdventHealth Sebring, FL, United States; Section of Cardiovascular Imaging, Cleveland Clinic, OH, United States
| | - Muhammad Sohaib Asghar
- Department of Internal Medicine, AdventHealth Sebring, FL, United States; Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, United States.
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Rasoul D, Ajay A, Abdullah A, Mathew J, Lee Wei En B, Mashida K, Sankaranarayanan R. Alcohol and Heart Failure. Eur Cardiol 2023; 18:e65. [PMID: 38213665 PMCID: PMC10782426 DOI: 10.15420/ecr.2023.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 10/10/2023] [Indexed: 01/13/2024] Open
Abstract
Alcohol is the most frequently consumed toxic substance in the world and remains a major global public health issue, with one in three adults consuming it worldwide. Alcohol use is a leading risk factor for disease, contributing to over 60 acute and chronic health conditions, with a particularly complex association with cardiovascular disease. Chronic excessive alcohol consumption is associated with a range of cardiac complications, including decreased myocardial contractility, hypertension, arrhythmias, MI and heart failure. However, low-level alcohol consumption is believed to have a protective effect against ischaemic heart disease and diabetes. In most cohort studies, small to moderate amounts of alcohol consumption have not been linked to heart failure, indicating a threshold effect of alcohol with individual (possibly genetic) predisposition rather than a continuous effect of exposure. This review article explores the potential benefits of alcohol on the heart, the association between alcohol use and alcoholic cardiomyopathy and the epidemiology, clinical correlates and management of alcoholic cardiomyopathy.
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Affiliation(s)
- Debar Rasoul
- Cardiology Department, Liverpool University Hospitals NHS Foundation TrustLiverpool, UK
- Liverpool Centre for Cardiovascular Science, University of LiverpoolLiverpool, UK
| | - Ashwin Ajay
- Cardiology Department, Liverpool University Hospitals NHS Foundation TrustLiverpool, UK
| | - Alend Abdullah
- Cardiology Department, The Dudley Group NHS Foundation TrustDudley, UK
| | - Jean Mathew
- Cardiology Department, Liverpool University Hospitals NHS Foundation TrustLiverpool, UK
| | - Benjamin Lee Wei En
- Cardiology Department, Liverpool University Hospitals NHS Foundation TrustLiverpool, UK
| | | | - Rajiv Sankaranarayanan
- Cardiology Department, Liverpool University Hospitals NHS Foundation TrustLiverpool, UK
- Liverpool Centre for Cardiovascular Science, University of LiverpoolLiverpool, UK
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5
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Xue Q, Liu X, Zhu R, Zhang T, Dong X, Jiang Y. Comprehensive analysis of transcriptomics and metabolomics to understand chronic ethanol induced murine cardiotoxicity. Mol Cell Biochem 2022; 478:1345-1359. [PMID: 36309883 DOI: 10.1007/s11010-022-04592-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 10/13/2022] [Indexed: 11/29/2022]
Abstract
Alcohol abuse has attracted public attention and long-term alcohol exposure can lead to alcohol-featured non-ischemic dilated cardiomyopathy. However, the precise underlying mechanisms of alcoholic cardiomyopathy remain to be elucidated. This study aimed to comprehensively characterize alcohol abuse-mediated effects on downstream metabolites and genes transcription using a multi-omics strategy. We established chronic ethanol intoxication model in adult male C57BL/6 mice through 8 weeks of 95% alcohol vapor administration and performed metabolomics analysis, mRNA-seq and microRNA-seq analysis with myocardial tissues. Firstly, ethanol markedly induced ejection fraction reductions, cardiomyocyte hypertrophy, and myocardial fibrosis in mice with myocardial oxidative injury. In addition, the omics analysis identified a total of 166 differentially expressed metabolites (DEMs), 241 differentially expressed genes (DEGs) and 19 differentially expressed microRNAs (DEmiRNAs), respectively. The results highlighted that alcohol abuse mainly interfered with endogenous lipids, amino acids and nucleotides production and the relevant genes transcription in mice hearts. Based on KEGG database, the affected signaling pathways are primarily mapped to the antigen processing and presentation, regulation of actin cytoskeleton, AMPK signaling pathway, tyrosine metabolism and PPAR signaling pathway, etc. Furthermore, 9 hub genes related to oxidative stress from DEGs were selected based on function annotation, and potential alcoholic cardiotoxic oxidative stress biomarkers were determined through establishing PPI network and DEmiRNAs-DEGs cross-talk. Altogether, our data strongly supported the conclusion that ethanol abuse characteristically affected amino acid and energy metabolism, nucleotide metabolism and especially lipids metabolism in mice hearts, and underlined the values of lipids signaling and oxidative stress in the treatment strategies.
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Affiliation(s)
- Qiupeng Xue
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai, 200032, China
| | - Xiaochen Liu
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai, 200032, China
| | - Rongzhe Zhu
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai, 200032, China
| | - Tianyi Zhang
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai, 200032, China
| | - Xiaoru Dong
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai, 200032, China
| | - Yan Jiang
- Department of Forensic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai, 200032, China.
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Andersson C, Schou M, Gustafsson F, Torp-Pedersen C. Alcohol Intake in Patients With Cardiomyopathy and Heart Failure: Consensus and Controversy. Circ Heart Fail 2022; 15:e009459. [PMID: 35593142 DOI: 10.1161/circheartfailure.121.009459] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Alcohol is often cited to be a common cause of cardiomyopathy and heart failure. However, in most available population-based studies, a modest-to-moderate alcohol consumption has been associated with favorable effects on the cardiovascular system, including a lowered risk of heart failure, compared with no alcohol consumption. Available genetic epidemiological data have not supported a causal association between alcohol consumption and heart failure risk, suggesting that alcohol may not be a common cause of heart failure in the community. Data linking alcohol intake with cardiomyopathy risk are sparse, and the concept of alcoholic cardiomyopathy stems mainly from case series of selected patients with dilated cardiomyopathy, where a large proportion reported a history of excessive alcohol intake. This state-of-the-art paper addresses the current knowledge of the epidemiology of alcoholic cardiomyopathy and the role of alcohol intake in patients with non-alcohol-related heart failure. It also offers directions to future research in the area. The review questions the validity of current clinical teaching in the area. It is not well known how much alcohol is needed to cause disease, and the epidemiological pathways linking alcohol consumption to cardiomyopathy and heart failure are not well understood. Until more evidence becomes available, caution is warranted before labeling patients as having alcoholic cardiomyopathy due to a risk of neglecting other contributors, such as genetic causes of cardiomyopathy. In non-alcohol-related heart failure, it is unknown whether total abstinence is improving outcomes (compared with moderate drinking). Ideally, randomized clinical trials are needed to answer this question.
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Affiliation(s)
- Charlotte Andersson
- Department of Medicine, Section of Cardiovascular Medicine, Boston Medical Center, Boston University, MA (C.A.)
| | - Morten Schou
- Department of Cardiology, Herlev and Gentofte Hospital (M.S.), University of Copenhagen, Denmark
| | - Finn Gustafsson
- The Heart Centre, Rigshospitalet (F.G.), University of Copenhagen, Denmark
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7
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Wang C, Li S, Liu Q, Qian Q, Fu A, Chen L, Zhang L, Suzaki T, Yu Z, Dou X. Ectopic accumulation of ceramide in cardiomyocytes modulates alcoholic cardiomyopathy via the TLR4-dependent pathway. Alcohol Clin Exp Res 2022; 46:1011-1022. [PMID: 35373347 DOI: 10.1111/acer.14822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 03/23/2022] [Accepted: 03/25/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND AIMS Excessive alcohol consumption predisposes drinkers to develop alcoholic cardiomyopathy. Although cardiomyocyte loss is the hallmark of cardiomyopathy, the underlying mechanism remains elusive. This study examined the potential mechanism of alcohol-induced cardiomyocyte death in a mouse model of alcoholic cardiomyopathy. METHODS We established the alcoholic cardiomyopathy mouse model using C57BL/6J mice and confirmed it via echocardiography and histological examination. The cardiac ceramide content and profile were analyzed with a triple-quadrupole mass spectrometer. The molecular mechanism underlying the accumulation of ceramide due to chronic alcohol consumption and ceramide-induced cardiomyocyte death were investigated by in vivo and in vitro models. Finally, we established a TLR4 mutation model to explore the function of TLR4 in CH3/HeJ mice. RESULTS Cardiac lipotoxicity that followed alcohol exposure resulted mainly in C16:0-, C18:0-, and C24:1-ceramide aggregation. Genes encoding the sphingosine hydrolysis enzymes (SMPD1 and SMPD2) rather than de novo synthetic biomarkers were markedly upregulated. Exogenous ceramide mimics (C6-ceramide) werenderlying the accumulation of ceramide observed to cause H9C2 cardiomyocyte-like cell death, which was consistent with results under palmate acid (PA) treatment. As a ceramide precursor, PA induces intracellular ceramide generation through TLR4 signaling, which can be abolished by an inhibitor of ceramide synthesis. Furthermore, mechanistic investigations demonstrated that pharmacological or genetic inhibition of TLR4 attenuated PA-induced cell death and corresponding ceramide production. Moreover, global mutation of TLR4 in CH3/HeJ mice significantly reduced the accumulation of C24:0, C24:1, OH_C24:1, and total ceramide following alcohol challenge. CONCLUSIONS Our findings demonstrate that ceramide accumulation plays a crucial role in alcoholic cardiomyopathy, effects that are partially mediated through the TLR4-dependent pathway.
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Affiliation(s)
- Cui Wang
- School of Life Science, Zhejiang Chinese Medical University, Hangzhou, China
| | - Songtao Li
- School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China
| | - Qingsheng Liu
- Hangzhou TCM Hospital of Zhejiang Chinese Medical University (Hangzhou Hospital of Traditional Chinese Medicine), Hangzhou, China
| | - Qianyu Qian
- School of Life Science, Zhejiang Chinese Medical University, Hangzhou, China
| | - Ai Fu
- School of Life Science, Zhejiang Chinese Medical University, Hangzhou, China
| | - Lin Chen
- School of Life Science, Zhejiang Chinese Medical University, Hangzhou, China
| | - Lei Zhang
- Jiaxing Dong Fang Guo Yao Prepared Decoction Pieces of Traditional, Chinese Medicine Co., Ltd., Jiaxing, China
| | | | - ZhiLing Yu
- School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, China
| | - Xiaobing Dou
- School of Life Science, Zhejiang Chinese Medical University, Hangzhou, 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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9
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Valverde-Gómez M, Ruiz-Curiel A, Melendo-Viu M, Salguero-Bodes R, Martín-Arriscado C, Bueno H, Jiménez-López-Guarch C, Rebolo-Bardanca P, Huertas-Nieto S, Montañés-Delmas E, Delgado-Jiménez J, Domínguez-González C, Arribas-Ynsaurriaga F, Palomino-Doza J. Electrocardiogram Changes in the Spectrum of TTNtv Dilated Cardiomyopathy: Accuracy and Predictive Value of a New Index for LV-Changes Identification. Heart Lung Circ 2021; 30:1487-1495. [PMID: 33994281 DOI: 10.1016/j.hlc.2021.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/12/2021] [Accepted: 04/01/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Truncating TTN variants (TTNtv) are the main cause of dilated cardiomyopathy (DCM). The dynamic nature of this entity has previously been described. Based on own empirical observations and previous evidences, this study assessed repolarisation patterns and the possible association with morphological and functional status of TTNtv-DCM patients. METHODS Electrocardiograms (ECGs) of index patients with TTNtv-DCM and their relatives were included and matched in time with an echocardiogram. All individuals were classified into five phenotype groups: 1) Reduced left ventricular ejection fraction (LVEF <50%); 2) Recovered LVEF: at least 10% increase and LVEF >30% after optimal medical treatment; 3) Borderline phenotype (mildly enlarged ventricle and/or hyper-trabeculation); 4) Genotype positive, phenotype negative; and 5) Non-carriers. All electrocardiograms were evaluated by two blinded observers in qualitative and quantitative terms [T index (mm)=Σ T-wave amplitude (V5, V6, II, aVF)] and these data were compared with demographic and clinical information. The Δ T-index was calculated in those individuals with more than one electrocardiogram. RESULTS Seventy-eight (78) electrocardiograms were included (46% female, mean age 50 years). T-index and prevalence of an abnormal T-wave had significantly different results among the groups (p<0.0001). Age and haemodynamic factors were shown to be ECG-modifiers, especially in phenotype-negative patients. T-index enabled individuals with reduced LVEF (<2.5) to be identified and to differentiate patients with favourable and unfavourable responses to treatment (Δ T index >3.5 and ≤2, respectively). CONCLUSION Repolarisation changes enabled characterisation of the spectrum of TTNtv-DCM. The T-index identified potential carriers and patients with the worst profiles of the spectrum of the disease.
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Affiliation(s)
- María Valverde-Gómez
- HealthInCode, La Coruña, Spain; Faculty of Medicine, Complutense University of Madrid, Spain.
| | - Aníbal Ruiz-Curiel
- Cardiology Department, 12 de Octubre University Hospital, Madrid, Spain; Research Institute i+12, 12 de Octubre University Hospital, Madrid, Spain
| | - María Melendo-Viu
- Cardiology Department, University Hospital Álvaro Cunqueiro, Vigo, Spain
| | - Rafael Salguero-Bodes
- Cardiology Department, 12 de Octubre University Hospital, Madrid, Spain; Research Institute i+12, 12 de Octubre University Hospital, Madrid, Spain; CIBER-CV (Biomedical Research Networking Centres, Cardiovascular Diseases), Institute of Health Carlos III, Madrid, Spain; Faculty of Medicine, Complutense University of Madrid, Spain
| | | | - Héctor Bueno
- Cardiology Department, 12 de Octubre University Hospital, Madrid, Spain; Research Institute i+12, 12 de Octubre University Hospital, Madrid, Spain; CIBER-CV (Biomedical Research Networking Centres, Cardiovascular Diseases), Institute of Health Carlos III, Madrid, Spain; Faculty of Medicine, Complutense University of Madrid, Spain
| | - Carmen Jiménez-López-Guarch
- Cardiology Department, 12 de Octubre University Hospital, Madrid, Spain; Research Institute i+12, 12 de Octubre University Hospital, Madrid, Spain; CIBER-CV (Biomedical Research Networking Centres, Cardiovascular Diseases), Institute of Health Carlos III, Madrid, Spain; Faculty of Medicine, Complutense University of Madrid, Spain
| | | | - Sergio Huertas-Nieto
- Cardiology Department, 12 de Octubre University Hospital, Madrid, Spain; Research Institute i+12, 12 de Octubre University Hospital, Madrid, Spain
| | - Elena Montañés-Delmas
- Cardiology Department, 12 de Octubre University Hospital, Madrid, Spain; Research Institute i+12, 12 de Octubre University Hospital, Madrid, Spain
| | - Juan Delgado-Jiménez
- Cardiology Department, 12 de Octubre University Hospital, Madrid, Spain; Research Institute i+12, 12 de Octubre University Hospital, Madrid, Spain; CIBER-CV (Biomedical Research Networking Centres, Cardiovascular Diseases), Institute of Health Carlos III, Madrid, Spain; Faculty of Medicine, Complutense University of Madrid, Spain
| | - Cristina Domínguez-González
- Research Institute i+12, 12 de Octubre University Hospital, Madrid, Spain; Neurology Department, 12 de Octubre University Hospital, Madrid, Spain; CIBERER (Biomedical Research Networking Centres, Rare Diseases), Institute of Health Carlos III, Madrid, Spain
| | - Fernando Arribas-Ynsaurriaga
- Cardiology Department, 12 de Octubre University Hospital, Madrid, Spain; Research Institute i+12, 12 de Octubre University Hospital, Madrid, Spain; CIBER-CV (Biomedical Research Networking Centres, Cardiovascular Diseases), Institute of Health Carlos III, Madrid, Spain; Faculty of Medicine, Complutense University of Madrid, Spain
| | - Julián Palomino-Doza
- Cardiology Department, 12 de Octubre University Hospital, Madrid, Spain; Research Institute i+12, 12 de Octubre University Hospital, Madrid, Spain; CIBER-CV (Biomedical Research Networking Centres, Cardiovascular Diseases), Institute of Health Carlos III, Madrid, Spain; Faculty of Medicine, Complutense University of Madrid, Spain
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10
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Li Z, Hu Z, Meng Y, Xu H, Wei Y, Shen D, Bai H, Yuan H, Chen L. miR-155-5p upregulation ameliorates myocardial insulin resistance via mTOR signaling in chronic alcohol drinking rats. PeerJ 2021; 9:e10920. [PMID: 33868799 PMCID: PMC8029671 DOI: 10.7717/peerj.10920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 01/19/2021] [Indexed: 11/28/2022] Open
Abstract
Background Chronic alcohol intake is associated with an increased risk of alcoholic cardiomyopathy, which may present with pathological changes such as myocardial insulin resistance, leading to ventricular dilation and cardiac dysfunction. Although a correlation between microRNA-155 (miR-155) and insulin signaling has been identified, the underlying mechanism has not been elucidated to date. The purpose of the study was to determine whether overexpression of miR-155-5p in vivo could ameliorate chronic alcohol-induced myocardial insulin resistance and cardiac dysfunction. Material and Methods Wistar rats were fed with either alcohol or water for 20 weeks to establish chronic alcohol intakes model. Then the alcohol group were divided into three groups: model group, miRNA-155 group and AAV-NC group. Rats undergoing alcohol treatment were injected with AAV-miRNA-155 (adeno-associated virus 9) or its negative control AAV-NC, respectively. Gene expression was determined by real-time PCR, and protein expression was determined by western blot. Echocardiography was performed to assess terminal cardiac function. Insulin responsiveness was determined through the quantification of phosphorylated insulin receptor substrate 1 (ser 307) and phosphorylated insulin receptor (Tyr 1185) levels. Results We found that cardiac function was attenuated in chronic alcohol intake rats, with an activated mammalian target of rapamycin (mTOR) signaling pathway, accompanied by an increase in p-IRS1(ser 307) and a decrease in p-IR (Tyr 1185) level in myocardial tissue. Also, alcohol drinking significantly up-regulated miR-155-5p level and its overexpression decreased p-IRS1 (ser 307) and increased p-IR (Tyr 1185) levels, and meanwhile inhibited the mTOR signaling pathway. Conclusion miR-155-5p upregulation ameliorates myocardial insulin resistance via the mTOR signaling in chronic alcohol drinking rats. We propose that miR-155 may serve as a novel potential therapeutic target for alcoholic heart disease.
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Affiliation(s)
- Zhaoping Li
- Department of Clinical Nutrition, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.,Department of Clinical Nutrition, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Zhenzhen Hu
- Department of Toxicology and Nutrition, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yan Meng
- Department of Clinical Nutrition, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.,Department of Clinical Nutrition, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Hongzhao Xu
- Department of Toxicology and Nutrition, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Yali Wei
- Department of Toxicology and Nutrition, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Deqiang Shen
- Department of Clinical Nutrition, Lianyungang Hospital Affiliated to Xuzhou Medical University, Lianyungang, Jiangsu, China
| | - Hao Bai
- Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang University, Hangzhou, Zhejiang, China
| | - Huacai Yuan
- Department of Clinical Nutrition, Qingdao Municipal Hospital, Qingdao, Shandong, China
| | - Liyong Chen
- Department of Clinical Nutrition, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China.,Department of Clinical Nutrition, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
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11
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Dundung A, Kumar A, Guria RT, Preetam M, Tara RK, Kumar B, Saba MK. Clinical profile and prognostic factors of alcoholic cardiomyopathy in tribal and non-tribal population. Open Heart 2020; 7:openhrt-2020-001335. [PMID: 33234711 PMCID: PMC7689074 DOI: 10.1136/openhrt-2020-001335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 09/25/2020] [Accepted: 10/23/2020] [Indexed: 12/12/2022] Open
Abstract
Objective Alcoholic cardiomyopathy (ACM) is a leading cause of non-ischaemic dilated cardiomyopathy (DCM) in tribal and non-tribal population. However, no study has been done depicting the correlation between clinical profile and prognosis of ACM in tribal and non-tribal population. This study also defines the long-term outcome and prognostic markers of ACM. Methods We studied 290 patients with ACM who were evaluated in our institute between January 2013 and December 2016. The primary endpoint of the study was all-cause mortality. Statistical analysis was done by using Kaplan-Meier survival curves for the assessment of all-cause mortality and Cox regression for the assessment of risk factors. Results After a median follow-up period of 3.75 years (IQR: 3–4 years), 50 patients with ACM (37.3%) died among tribal population while 14 patients (9%) died among non-tribal population. Independent predictors of all-cause mortality in ACM identified by Cox regression were left ventricular ejection fraction (LVEF) (HR: 0.883; 95% CI 0.783 to 0.996; p=0.043), QRS duration (HR: 1.010; 95% CI 1.007 to 1.017; p=0.005) and Child-Turcotte-Pugh (CTP) Scoring (HR: 12.332; 95% CI 6.999 to 21.728; p<0.001) at admission. The Kaplan-Meier survival probability estimate was 95.1% at 1 year and all-cause mortality was found to be higher in patients with QRS>120 ms, LVEF ≤35%, CTP Grade B/C than patients with QRS≤120 ms, LVEF >35% and CTP Score A, respectively (log-rank χ²=55.088, p<0.001; log-rank χ²=32.953, p<0.001; log-rank χ²=139.764, p<0.001, respectively). Conclusion Our study indicated increased morbidity and mortality in tribal population. LVEF, QRS duration and CTP Scoring at the time of presentation were found to be the independent prognostic markers of patients with ACM.
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Affiliation(s)
- Ajit Dundung
- Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Abhinav Kumar
- Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Rishi Tuhin Guria
- Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Mukul Preetam
- Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Ruth K Tara
- Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
| | - Bindey Kumar
- Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India
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Abstract
Cardiovascular disease (CVD) is a leading cause of morbidity and mortality for women. This review summarizes the relationship between alcohol consumption and common CVDs in women and highlights potential differences from men. Except for risk of hypertension, no sex-related effects of alcohol consumption on the risk for coronary heart disease and stroke have been reported, and data on the sex-related effects on risk for peripheral arterial disease are limited. For women, alcohol consumption has a J-shaped relationship with hypertension. About 1 to 2 standard drinks per day is associated with lower risk for the development of hypertension, whereas for men, the relationship is relatively linear. In the area of alcoholic cardiomyopathy, the prevalence is greater for men, but women may develop alcoholic cardiomyopathy at a lower lifetime level of alcohol consumption. Overall, data support that 1 to 2 standard drinks per day for women and men is associated with a lower risk of CVD, and higher daily amounts may increase the risk of CVD.
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Affiliation(s)
- Mariann R Piano
- School of Nursing, Vanderbilt University, Nashville, Tennessee
| | - Laurel A Thur
- School of Nursing, Vanderbilt University, Nashville, Tennessee
| | - Chueh-Lung Hwang
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, Illinois
| | - Shane A Phillips
- Department of Physical Therapy, University of Illinois at Chicago, Chicago, Illinois
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13
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Sulaiman S, Yousef N, Benjamin MM, Sundararajan S, Wingert R, Wingert M, Mohammed A, Jahangir A. Burden of arrhythmia and electrophysiologic procedures in alcoholic cardiomyopathy hospitalizations. Int J Cardiol 2020; 304:61-68. [DOI: 10.1016/j.ijcard.2020.01.068] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/17/2019] [Accepted: 01/27/2020] [Indexed: 01/01/2023]
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14
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Mogos MF, Salemi JL, Phillips SA, Piano MR. Contemporary Appraisal of Sex Differences in Prevalence, Correlates, and Outcomes of Alcoholic Cardiomyopathy. Alcohol Alcohol 2020; 54:386-395. [PMID: 31206165 DOI: 10.1093/alcalc/agz050] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 05/19/2019] [Accepted: 06/07/2019] [Indexed: 11/14/2022] Open
Abstract
AIMS The aims of this study were to: examine differences in alcoholic cardiomyopathy (ACM) prevalence, temporal trends and the distribution of socio-demographic factors and comorbidities by sex; and investigate differences in selected inpatient outcomes between women and men with ACM. METHODS We used the 2002-2014 Nationwide Inpatient Sample databases. Overall and sex-specific rates of ACM were estimated across sociodemographic, clinical, and hospital characteristics. Joinpoint regression was used to estimate temporal trends (annual percent change [APC]) of ACM-related hospitalization by sex and race/ethnicity. Adjusted odds ratios (AOR) representing associations between sex and selected ACM outcomes were calculated using survey logistic regression. RESULTS The rate of ACM among all inpatient men and women was 128 per 100,000 and 17 per 100,000 hospitalizations, respectively. Among women, the rate of ACM remained unchanged during the study period, while for men, there was 1.2% annual reduction from 2002-2010 (APC -1.3, 95% CI: -1.7, -0.8). Women with ACM were more likely than men with ACM to experience depression (AOR=2.24, 95% CI: 2.06-2.43) and anxiety (AOR=1.94, 95% CI: 1.75-2.15), while men with ACM were 21% and 24% more likely than women with ACM to experience 'any heart failure (HF)' and HF with reduced ejection fraction respectively. One in 1,471 hospitalizations were related to ACM with a male-to-female ratio of 8:1. CONCLUSION Individuals with ACM are at increased likelihood of adverse outcomes. Women with ACM are at increased risk of depression and anxiety, while men are at increased risk of HF.
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Affiliation(s)
- Mulubrhan F Mogos
- Department of Women, Children and Family Health Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Jason L Salemi
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Shane A Phillips
- Department of Physical Therapy, Integrative Physiology Laboratory, College of Applied Health Sciences, University of Illinois at Chicago, Chicago, IL, USA
| | - Mariann R Piano
- Center for Research Development and Scholarship, Vanderbilt School of Nursing, Nashville, TN, USA
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15
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Rodrigues P, Santos-Ribeiro S, Teodoro T, Gomes FV, Leal I, Reis JP, Goff DC, Gonçalves A, Lima JAC. Association Between Alcohol Intake and Cardiac Remodeling. J Am Coll Cardiol 2019; 72:1452-1462. [PMID: 30236306 DOI: 10.1016/j.jacc.2018.07.050] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 07/02/2018] [Accepted: 07/03/2018] [Indexed: 01/12/2023]
Abstract
BACKGROUND Alcohol-induced cardiotoxicity is incompletely understood. Specifically, the long-term impact of alcohol use on ventricular remodeling or dysfunction, its modulators, and effect thresholds among young adults remain controversial. OBJECTIVES The authors sought to evaluate a potential relationship between alcohol intake and cardiac remodeling, assessed by echocardiography, over 20 years of follow-up. METHODS Among the CARDIA (Coronary Artery Risk Development in Young Adults) study cohort, the authors studied all subjects without baseline heart disorders who provided adequate information on their drinking habits and underwent echocardiographic evaluation at years 5 and 25 of the study. The echocardiographic outcomes were left ventricular (LV) ejection fraction, indexed LV end-diastolic volume and LV mass, and left atrial diameter. Participants were grouped according to their weighted-average weekly drinking habits. An additional analysis used the estimated cumulative alcohol consumption. Regression models and multivariable fractional polynomials were used to evaluate the association between alcohol consumption and the outcomes. RESULTS Among the 2,368 participants, alcohol consumption was an independent predictor of higher indexed LV mass (p = 0.014) and indexed LV end-diastolic volume (p = 0.037), regardless of sex. No significant relationship between alcohol intake and LV ejection fraction was found. Drinking predominantly wine was associated with less cardiac remodeling and there was a nonsignificant trend for a harmful effect of binge drinking. CONCLUSIONS After 20 years of follow-up, alcohol intake was associated with adverse cardiac remodeling, although it was not related with LV systolic dysfunction in this initially healthy young cohort. Our results also suggest that drinking predominantly wine associates with less deleterious findings in cardiac structure.
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Affiliation(s)
- Patrícia Rodrigues
- Cardiology Department, Barts Heart Center, London, United Kingdom (when this work was initiated); Cardiology Department, Centro Hospitalar do Porto, Porto, Portugal.
| | - Samuel Santos-Ribeiro
- Centrum voor Reproductieve Geneeskunde, Universitair Ziekenhuis Brussels, Brussels, Belgium; Gynecology and Obstetrics Department, Centro Hospitalar de Lisboa Norte, Lisbon, Portugal
| | - Tiago Teodoro
- Neurology Department, St. George's, University of London, London, United Kindgom; Instituto de Medicina Molecular of the University of Lisbon, Santa Maria Hospital, Lisbon, Portugal
| | | | - Inês Leal
- Ophtalmology Department, Centro Hospitalar de Lisboa Norte, Lisbon, Portugal
| | - Jared P Reis
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - David C Goff
- Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, Bethesda, Maryland; Colorado School of Public Health, Aurora, Colorado (when this work was initiated)
| | | | - João A C Lima
- Johns Hopkins University School of Medicine, Baltimore, Maryland
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16
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Alcoholic Cardiomyopathy: Is it Time for Genetic Testing? J Am Coll Cardiol 2019; 71:2303-2305. [PMID: 29773158 DOI: 10.1016/j.jacc.2018.03.463] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 03/23/2018] [Indexed: 11/23/2022]
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Effects of the (Pro)renin Receptor on Cardiac Remodeling and Function in a Rat Alcoholic Cardiomyopathy Model via the PRR-ERK1/2-NOX4 Pathway. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2019; 2019:4546975. [PMID: 31049135 PMCID: PMC6462324 DOI: 10.1155/2019/4546975] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/09/2019] [Accepted: 01/27/2019] [Indexed: 12/14/2022]
Abstract
Alcoholic cardiomyopathy (ACM) caused by alcohol consumption manifests mainly as by maladaptive myocardial function, which eventually leads to heart failure and causes serious public health problems. The (pro)renin receptor (PRR) is an important member of the local tissue renin-angiotensin system and plays a vital role in many cardiovascular diseases. However, the mechanism responsible for the effects of PRR on ACM remains unclear. The purpose of this study was to determine the role of PRR in myocardial fibrosis and the deterioration of cardiac function in alcoholic cardiomyopathy. Wistar rats were fed a liquid diet containing 9% v/v alcohol to establish an alcoholic cardiomyopathy model. Eight weeks later, rats were injected with 1 × 109v.g./100 μl of recombinant adenovirus containing EGFP (scramble-shRNA), PRR, and PRR-shRNA via the tail vein. Cardiac function was assessed by echocardiography. Cardiac histopathology was measured by Masson's trichrome staining, immunohistochemical staining, and dihydroethidium staining. In addition, cardiac fibroblasts (CFs) were cultured to evaluate the effects of alcohol stimulation on the production of the extracellular matrix and their underlying mechanisms. Our results indicated that overexpression of PRR in rats with alcoholic cardiomyopathy exacerbates myocardial oxidative stress and myocardial fibrosis. Silencing of PRR expression with short hairpin RNA (shRNA) technology reversed the myocardial damage mediated by PRR. Additionally, PRR activated phosphorylation of ERK1/2 and increased NOX4-derived reactive oxygen species and collagen expression in CFs with alcohol stimulation. Administration of the ERK kinase inhibitor (PD98059) significantly reduced NOX4 protein expression and collagen production, which indicated that PRR increases collagen production primarily through the PRR-ERK1/2-NOX4 pathway in CFs. In conclusion, our study demonstrated that PRR induces myocardial fibrosis and deteriorates cardiac function through ROS from the PRR-ERK1/2-NOX4 pathway during ACM development.
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Mustroph J, Lebek S, Maier LS, Neef S. Mechanisms of cardiac ethanol toxicity and novel treatment options. Pharmacol Ther 2018; 197:1-10. [PMID: 30557629 DOI: 10.1016/j.pharmthera.2018.12.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Ethanol can acutely and chronically alter cardiomyocyte and whole-organ function in the heart. Importantly, ethanol acutely and chronically predisposes to arrhythmias, while chronic abuse can induce heart failure. However, the molecular mechanisms of ethanol toxicity in the heart are incompletely understood. In this review, we summarize the current mechanistic knowledge on cardiac ethanol toxicity, with a focus on druggable pathways. Ethanol effects on excitation-contraction coupling, oxidative stress, apoptosis, and cardiac metabolism, as well as effects of ethanol metabolites will be discussed. Important recent findings have been gained by investigation of acute ethanol effects. These include a renewed focus on reactive oxygen species (ROS) and induction of SR Ca2+ leak by CaMKII-mediated pathways downstream of ROS. Furthermore, a clinical outlook into potential novel treatment options is provided.
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Affiliation(s)
- Julian Mustroph
- Department of Internal Medicine II, University Medical Center Regensburg, Germany
| | - Simon Lebek
- Department of Internal Medicine II, University Medical Center Regensburg, Germany
| | - Lars S Maier
- Department of Internal Medicine II, University Medical Center Regensburg, Germany
| | - Stefan Neef
- Department of Internal Medicine II, University Medical Center Regensburg, Germany.
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19
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Ram P, Lo KB, Shah M, Patel B, Rangaswami J, Figueredo VM. National trends in hospitalizations and outcomes in patients with alcoholic cardiomyopathy. Clin Cardiol 2018; 41:1423-1429. [PMID: 30178565 DOI: 10.1002/clc.23067] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/23/2018] [Accepted: 08/30/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Numerous studies have shown conflicting results regarding the natural history and outcomes with alcoholic cardiomyopathy (AC). HYPOTHESIS Determining the trends in hospitalization among patients with AC and associated outcomes will facilitate a better understanding of this disease. METHODS We conducted our analysis on discharge data from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) from 2002 through 2014. We obtained data from patients aged ≥18 years with diagnosis of "Alcoholic Cardiomyopathy." Death was defined within the NIS as in-hospital mortality. By using International Classification of Disease-9th edition-Clinical Modification (ICD-9CM) diagnoses and diagnosis-related groups different comorbidities were identified. RESULTS We studied a total of 45 365 admissions among patients with AC. The absolute number of admissions decreased from 2002 to 2014 (3866-2834 admissions). In-hospital mortality was variable throughout study duration without a clinically relevant trend (Mean 4.5%, range 3.6%-5.6%). The patients were mostly male (87%) and Caucasian (50.5%). Commonest age groups involved were 45-59 years (46.7%) followed by 60-74 years (29.2%). Trends in associated comorbidities such as smoking, drug abuse, depression, and hypertension increased over the same time period. Among all admissions, almost half were for cardiovascular etiologies (48.9%) and heart failure (≈24%) was the commonest reason for hospital admission. CONCLUSION While the overall admissions among patients with AC decreased over time, the proportion of patients with high-risk characteristics such as smoking, depression, and drug abuse increased. Patients aged 45 and older were largely affected and cardiovascular etiologies predominated among causes for admission.
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Affiliation(s)
- Pradhum Ram
- Department of Medicine, Albert Einstein Medical Center, Philadelphia, Pennsylvania
| | - Kevin B Lo
- Department of Medicine, Albert Einstein Medical Center, Philadelphia, Pennsylvania
| | - Mahek Shah
- Department of Cardiology, Montefiore Medical Center, Bronx, New York
| | - Brijesh Patel
- Department of Cardiology, Lehigh Valley Hospital, Allentown, Pennsylvania
| | - Janani Rangaswami
- Department of Medicine, Albert Einstein Medical Center, Philadelphia, Pennsylvania
| | - Vincent M Figueredo
- Department of Cardiology, Albert Einstein Medical Center, Philadelphia, Pennsylvania
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Zhou C, Huang J, Li Q, Zhan C, He Y, Liu J, Wen Z, Wang DW. Pharmacological Inhibition of Soluble Epoxide Hydrolase Ameliorates Chronic Ethanol-Induced Cardiac Fibrosis by Restoring Autophagic Flux. Alcohol Clin Exp Res 2018; 42:1970-1978. [PMID: 30047995 DOI: 10.1111/acer.13847] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 07/09/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Chronic drinking leads to myocardial contractile dysfunction and dilated cardiomyopathy, and cardiac fibrosis is a consequence of these alcoholic injuries. Soluble epoxide hydrolase (sEH) hydrolyzes epoxyeicosatrienoic acids (EETs) to less bioactive diols, and EETs have cardioprotective properties. However, the effects of sEH inhibition in ethanol (EtOH)-induced cardiac fibrosis are unknown. METHODS This study was designed to investigate the role and underlying mechanisms of sEH inhibition in chronic EtOH feeding-induced cardiac fibrosis. C57BL/6J mice were fed a 4% Lieber-DeCarli EtOH diet for 8 weeks, and the sEH inhibitor 1-trifluoromethoxyphenyl-3-(1-propionylpiperidin-4-yl) urea (TPPU) was administered throughout the experimental period. RESULTS The results showed that chronic EtOH intake led to cardiac dilatation, collagen deposition, and autophagosome accumulation, while TPPU administration ameliorated these effects. In vitro, treating primary cardiac fibroblasts (CFs) with EtOH resulted in CF activation, including alpha smooth muscle actin overexpression, collagen synthesis, and cell migration. Moreover, EtOH disturbed CF autophagic flux, as evidenced by the increased LC3 II/I ratio and SQSTM1 expression, and by the enhanced autophagosome accumulation. TPPU treatment prevented the activation of CF induced by EtOH and restored the impaired autophagic flux by suppressing mTOR activation. CONCLUSIONS Taken together, these findings suggest that sEH pharmacological inhibition may be a unique therapeutic strategy for treating EtOH-induced cardiac fibrosis.
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Affiliation(s)
- Chi Zhou
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, and Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, China
| | - Jin Huang
- Division of Hematology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, China
| | - Qing Li
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, and Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, China
| | - Chenao Zhan
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, and Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, China
| | - Ying He
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, and Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, China
| | - Jinyan Liu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, and Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, China
| | - Zheng Wen
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, and Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, China
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, and Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan, China
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Fang W, Luo R, Tang Y, Hua W, Fu M, Chen W, Lai L, Li X. The Prognostic Factors of Alcoholic Cardiomyopathy: A single-center cohort study. Medicine (Baltimore) 2018; 97:e11744. [PMID: 30075591 PMCID: PMC6081072 DOI: 10.1097/md.0000000000011744] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Alcoholic cardiomyopathy (ACM) is considered one of the main causes of left ventricular dysfunction and is the leading cause of nonischemic dilated cardiomyopathy (DCM) in developed countries. However, very few studies have investigated the relationship between clinical characteristics and prognosis in ACM. AIMS This study aimed to identify risk factors related to a poor outcome in ACM patients. STUDY DESIGN Retrospective cohort study. METHODS This study included 321 patients with ACM admitted to our hospital between 2003 and 2013. This study aimed to investigate the clinical characteristics and outcomes of the patients with ACM, and the primary endpoint of the study was all-cause mortality, which was assessed through patient medical records (review of patient hospital records and periodic examination of patients in the outpatient clinic) and medical follow-up calls with trained personnel. All-cause mortality was assessed using Kaplan-Meier survival curves, and the risk factors were assessed using Cox regression. A receiver operating characteristic (ROC) curve analysis was performed to optimize the cutoff point for discriminating between the 2 risk groups. RESULTS After a median follow-up period of 3.78 years (interquartile range: 2.08-6.52 years), 83 (27.7%) patients were dead. The independent predictors of all-cause mortality due to ACM were the QRS duration (HR: 1.014; 95% CI: 1.004-1.019; P = .003), systolic blood pressure (HR: 0.980; 95% CI: 0.963- 0.997; P = .020), and New York Heart Association classification (HR: 1.595; 95% CI: 1.110-2.290; P = .011) at admission. CONCLUSION Our study indicated that the QRS duration, systolic blood pressure, and New York Heart Association classification at admission provided independent prognostic information in patients with ACM.
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Affiliation(s)
- Wei Fang
- Medical School of the University of Electronic Science and Technology of China
| | - Rong Luo
- Institute of Cardiovascular Disease, Chengdu Medical College
| | - Yibin Tang
- Department of Laboratory Medicine, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan
| | - Wei Hua
- Cardiac Arrhythmia Center, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Michael Fu
- Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Göteborg, Sweden
| | - Weizhong Chen
- Institute of Cardiovascular Disease, Chengdu Medical College
| | - Li Lai
- Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China
| | - Xiaoping Li
- Medical School of the University of Electronic Science and Technology of China
- Department of Cardiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan
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Malhotra J, Boffetta P. Association of Increased Cancer Risk With Heart Failure. J Am Coll Cardiol 2018; 68:272-273. [PMID: 27417005 DOI: 10.1016/j.jacc.2016.05.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 05/12/2016] [Accepted: 05/17/2016] [Indexed: 01/22/2023]
Affiliation(s)
- Jyoti Malhotra
- Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey
| | - Paolo Boffetta
- Icahn School of Medicine at Mount Sinai, New York, New York.
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24
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Amor-Salamanca A, Guzzo-Merello G, González-López E, Domínguez F, Restrepo-Córdoba A, Cobo-Marcos M, Gómez-Bueno M, Segovia-Cubero J, Alonso-Pulpón L, García-Pavía P. Impacto pronóstico y factores predictores de la recuperación de la fracción de eyección en pacientes con miocardiopatía dilatada alcohólica. Rev Esp Cardiol 2018. [DOI: 10.1016/j.recesp.2017.11.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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25
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Hung CL, Chang SC, Chang SH, Chi PC, Lai YJ, Wang SW, Wu YJ, Yeh HI, Lin SJ, Chen CH, Mochly-Rosen D, Wang LY. Genetic Polymorphisms of Alcohol Metabolizing Enzymes and Alcohol Consumption are Associated With Asymptomatic Cardiac Remodeling and Subclinical Systolic Dysfunction in Large Community-Dwelling Asians. Alcohol Alcohol 2018; 52:638-646. [PMID: 29016726 DOI: 10.1093/alcalc/agx049] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 07/16/2017] [Indexed: 01/14/2023] Open
Abstract
Aims Excessive consumption of alcoholic beverages is associated with cardiac remodeling and cardiomyopathy. We examined the possible association of alcohol use, common Asian genetic variants in genes involved in alcohol metabolism, and cardiac structures/functions alterations. Methods A prospective, community-dwelling survey among individuals with available complete echocardiography examined the associations of alcohol use, cardiac structure/functions, and three common alcohol metabolizing genetic variants, including aldehyde dehydrogenase 2 (ALDH2), alcohol dehydrogenase 1B (ADH1B) and cytochrome P450 (CYP) isoform 2E1 (CYP2E1). Results Among 1577 participants (mean age: 53 ± 9, 59.7% female), we observed that in subjects with more frequent weekly ethanol intake showed greater left ventricle (LV) mass, more impaired diastolic functions, and reduced global longitudinal strain (GLS), systolic (SRs) and early diastolic strain rates (SRe) (P<0.05). After propensity matching for clinical confounders (n = 330:30 for frequent users and non-users), frequent alcohol use and subjects carrying ALDH2 (A/G or A/A), ADH1B (A/A) or CYP2E1(T/C or T/T) polymorphisms were all associated with worse GLSRs and GLSRe, with combined alcohol use and any given genetic variant aggravated these associations (all P < 0.05). Finally, we observed Gene-Gene synergistic effects on LV functional decline in frequent alcohol users by using linear mixed effect model (all interaction P < 0.05). Conclusions Among East Asians, even moderate alcohol consumption can confer subclinical adverse effects on cardiac systolic functions, which was most pronounced in subjects carrying common variants in alcohol metabolizing genes. These findings challenge the notion of beneficial influences of less heavy ethanol consumption on the heart, especially among East Asians. Short summary This study evaluated the association of level of alcohol consumption and genetic variants in genes involved in alcohol metabolism with changes in cardiac function in East Asians. Even moderate alcohol use conferred subclinical adverse effects on cardiac systolic functions, which were most pronounced in subjects carrying common alcohol metabolizing genes.
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Affiliation(s)
- Chung-Lieh Hung
- Department of Medicine, MacKay Medical College, No. 46, Sec. 3, Zhongzheng Rd. New Taipei City Sanzhi Dist. 252, New Taipei City 25245, Taiwan.,Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, No. 92, Section 2, Chung Shan North Road, Taipei 10449, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, No. 155, Sec. 2, Linong Street, Taipei 112, Taiwan
| | - Shun-Chuan Chang
- Department of Medicine, MacKay Medical College, No. 46, Sec. 3, Zhongzheng Rd. New Taipei City Sanzhi Dist. 252, New Taipei City 25245, Taiwan
| | - Sheng-Hsiung Chang
- Department of Medicine, MacKay Medical College, No. 46, Sec. 3, Zhongzheng Rd. New Taipei City Sanzhi Dist. 252, New Taipei City 25245, Taiwan.,Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, No. 92, Section 2, Chung Shan North Road, Taipei 10449, Taiwan
| | - Po-Ching Chi
- Department of Medicine, MacKay Medical College, No. 46, Sec. 3, Zhongzheng Rd. New Taipei City Sanzhi Dist. 252, New Taipei City 25245, Taiwan.,Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, No. 92, Section 2, Chung Shan North Road, Taipei 10449, Taiwan
| | - Yu-Jun Lai
- Department of Medicine, MacKay Medical College, No. 46, Sec. 3, Zhongzheng Rd. New Taipei City Sanzhi Dist. 252, New Taipei City 25245, Taiwan.,Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, No. 92, Section 2, Chung Shan North Road, Taipei 10449, Taiwan
| | - Shih-Wei Wang
- Department of Medicine, MacKay Medical College, No. 46, Sec. 3, Zhongzheng Rd. New Taipei City Sanzhi Dist. 252, New Taipei City 25245, Taiwan.,Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, No. 92, Section 2, Chung Shan North Road, Taipei 10449, Taiwan
| | - Yih-Jer Wu
- Department of Medicine, MacKay Medical College, No. 46, Sec. 3, Zhongzheng Rd. New Taipei City Sanzhi Dist. 252, New Taipei City 25245, Taiwan.,Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, No. 92, Section 2, Chung Shan North Road, Taipei 10449, Taiwan
| | - Hung-I Yeh
- Department of Medicine, MacKay Medical College, No. 46, Sec. 3, Zhongzheng Rd. New Taipei City Sanzhi Dist. 252, New Taipei City 25245, Taiwan.,Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, No. 92, Section 2, Chung Shan North Road, Taipei 10449, Taiwan
| | - Shing-Jong Lin
- Division of Cardiology, Department of Internal Medicine, Mackay Memorial Hospital, No. 92, Section 2, Chung Shan North Road, Taipei 10449, Taiwan
| | - Che-Hong Chen
- Department of Chemical and Systems Biology, School of Medicine, Stanford University, 269 Campus Drive, CCSR Building Stanford, CA 94305, USA
| | - Daria Mochly-Rosen
- Department of Chemical and Systems Biology, School of Medicine, Stanford University, 269 Campus Drive, CCSR Building Stanford, CA 94305, USA
| | - Li-Yu Wang
- Department of Medicine, MacKay Medical College, No. 46, Sec. 3, Zhongzheng Rd. New Taipei City Sanzhi Dist. 252, New Taipei City 25245, Taiwan
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26
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Fernández Solà J. Reversibility of Alcohol Dilated Cardiomyopathy. ACTA ACUST UNITED AC 2018; 71:603-605. [PMID: 29653776 DOI: 10.1016/j.rec.2018.01.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 01/08/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Joaquim Fernández Solà
- Unidad de Alcohología, Servicio de Medicina Interna, Hospital Clínic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
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27
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Amor-Salamanca A, Guzzo-Merello G, González-López E, Domínguez F, Restrepo-Córdoba A, Cobo-Marcos M, Gómez-Bueno M, Segovia-Cubero J, Alonso-Pulpón L, García-Pavía P. Prognostic Impact and Predictors of Ejection Fraction Recovery in Patients With Alcoholic Cardiomyopathy. ACTA ACUST UNITED AC 2018; 71:612-619. [PMID: 29650446 DOI: 10.1016/j.rec.2017.11.032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Accepted: 11/20/2017] [Indexed: 12/31/2022]
Abstract
INTRODUCTION AND OBJECTIVES Recovery of left ventricular ejection fraction (LVEF) has been described in alcoholic cardiomyopathy (ACM) after a period of alcohol withdrawal. Nevertheless, the prognostic impact of LVEF recovery in ACM and its determinants have not been studied. We sought to define the role of LVEF improvement in the long-term outcome of ACM and to identify predictors of LVEF recovery in these patients. METHODS We evaluated 101 ACM patients during a median follow-up period of 82 months [interquartile range 36-134]. RESULTS At latest follow-up, 42 patients (42%) showed substantial LVEF recovery defined as an absolute increase in LVEF ≥ 10% to a final value of ≥ 40%. Patients who recovered LVEF had better outcomes than patients who did not (heart transplant or cardiovascular death 1% vs 30%; P <.001). A QRS with <120ms (OR, 6.68; 95%CI, 2.30-19.41), beta-blocker therapy (OR, 3.01; 95%CI, 1.09-8.28), and the absence of diuretics (OR, 3.35; 95%CI, 1.08-10.42) predicted LVEF recovery in multivariate analysis. Although alcohol cessation did not predict LVEF recovery, none of the patients (n=6) who persisted with heavy alcohol consumption recovered LVEF. The rate of patients who recovered LVEF did not differ between abstainers and moderate drinkers (44% vs 45%; P=.9). CONCLUSIONS The LVEF recovery is associated with an excellent prognosis in ACM. Beta-blocker treatment, QRS <120ms and absence of diuretics are independent predictors of LVEF recovery. LVEF recovery is similar in moderate drinkers and abstainers.
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Affiliation(s)
- Almudena Amor-Salamanca
- Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Gonzalo Guzzo-Merello
- Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Madrid, Spain; Servicio de Cardiología, Hospital General de Villalba, Villalba, Madrid, Spain
| | - Esther González-López
- Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Madrid, Spain; CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Fernando Domínguez
- Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Madrid, Spain; CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Alejandra Restrepo-Córdoba
- Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Marta Cobo-Marcos
- Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Madrid, Spain; CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Manuel Gómez-Bueno
- Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Madrid, Spain; CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Javier Segovia-Cubero
- Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Madrid, Spain; CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Luis Alonso-Pulpón
- Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Madrid, Spain; CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Pablo García-Pavía
- Unidad de Insuficiencia Cardiaca y Cardiopatías Familiares, Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Madrid, Spain; CIBER Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Facultad de Ciencias de la Salud, Universidad Francisco de Vitoria, Pozuelo de Alarcón, Madrid, Spain.
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28
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Zhou C, Huang J, Li Q, Zhan C, Xu X, Zhang X, Ai D, Zhu Y, Wen Z, Wang DW. CYP2J2-derived EETs attenuated ethanol-induced myocardial dysfunction through inducing autophagy and reducing apoptosis. Free Radic Biol Med 2018; 117:168-179. [PMID: 29427791 DOI: 10.1016/j.freeradbiomed.2018.02.009] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Revised: 01/16/2018] [Accepted: 02/05/2018] [Indexed: 12/19/2022]
Abstract
Chronic excessive drinking leads to myocardial contractile dysfunction and dilated cardiomyopathy, where ethanol toxicity plays an essential role. Cytochrome P450 (CYP) epoxygenases metabolize arachidonic acids to form epoxyeicosatrienoic acids (EETs), which exert beneficial roles in the cardiovascular system, but their role in alcoholic cardiomyopathy is elusive. This study was designed to evaluate the effects and mechanisms of CYP2J2 gene delivery on ethanol-induced myocardial dysfunction with focus on autophagy and apoptosis. C57BL/6 J mice were challenged with a 4% Lieber-DeCarli ethanol liquid diet for 8 weeks, before which rAAV9-CYP2J2 was injected via the tail vein. Cardiac function was assessed using echocardiography, hemodynamic measurement, and cardiac histology. The results showed that chronic ethanol intake led to cardiac dilation, contractile dysfunction, cardiomyocyte hypertrophy, oxidative stress, and cardiomyocyte apoptosis, while CYP2J2 overexpression ameliorated these effects. Additionally, chronic ethanol consumption triggered myocardial autophagosome formation, but impaired autophagic flux via disrupting autophagosome-lysosome fusion, as evidenced by increased LC3 II/I, Beclin-1 and SQSTM1 levels, but reduced LAMP-2 expression. Interestingly, rAAV9-CYP2J2 treatment exerted cardioprotection via restoring autophagic flux in the alcoholic myocardium. Similarly, exogenous 11,12-EET addition significantly restored ethanol-induced neonatal rat cardiomyocyte autophagic flux impairment and inhibited apoptosis, both of which were mediated by AMPK/mTOR signaling pathway in vitro. In conclusion, our data suggest that CYP2J2-derived EETs attenuate ethanol-induced myocardial dysfunction through inducing autophagy and reducing apoptosis.
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Affiliation(s)
- Chi Zhou
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, and Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan 430030, China
| | - Jin Huang
- Division of Hematology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430030, China
| | - Qing Li
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, and Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan 430030, China
| | - Chenao Zhan
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, and Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan 430030, China
| | - Xizhen Xu
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, and Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan 430030, China
| | - Xu Zhang
- Tianjin Key Laboratory of Metabolic Diseases, Collaborative Innovation Center of Tianjin for Medical Epigenetics, Department of Physiology and Pathophysiology, Tianjin Medical University, Tianjin 300070, China
| | - Ding Ai
- Tianjin Key Laboratory of Metabolic Diseases, Collaborative Innovation Center of Tianjin for Medical Epigenetics, Department of Physiology and Pathophysiology, Tianjin Medical University, Tianjin 300070, China
| | - Yi Zhu
- Tianjin Key Laboratory of Metabolic Diseases, Collaborative Innovation Center of Tianjin for Medical Epigenetics, Department of Physiology and Pathophysiology, Tianjin Medical University, Tianjin 300070, China
| | - Zheng Wen
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, and Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan 430030, China.
| | - Dao Wen Wang
- Division of Cardiology, Department of Internal Medicine, Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology, and Hubei Key Laboratory of Genetics and Molecular Mechanisms of Cardiological Disorders, Wuhan 430030, China.
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29
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Mustroph J, Wagemann O, Lebek S, Tarnowski D, Ackermann J, Drzymalski M, Pabel S, Schmid C, Wagner S, Sossalla S, Maier LS, Neef S. SR Ca 2+-leak and disordered excitation-contraction coupling as the basis for arrhythmogenic and negative inotropic effects of acute ethanol exposure. J Mol Cell Cardiol 2018; 116:81-90. [PMID: 29410242 DOI: 10.1016/j.yjmcc.2018.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 01/23/2018] [Accepted: 02/01/2018] [Indexed: 02/03/2023]
Abstract
AIMS Ethanol has acute negative inotropic and arrhythmogenic effects. The underlying mechanisms, however, are largely unknown. Sarcoplasmic reticulum Ca2+-leak is an important mechanism for reduced contractility and arrhythmias. Ca2+-leak can be induced by oxidative stress and Ca2+/Calmodulin-dependent protein kinase II (CaMKII). Therefore, we investigated the influence of acute ethanol exposure on excitation-contraction coupling in atrial and ventricular cardiomyocytes. METHODS AND RESULTS Isolated human atrial and murine atrial or ventricular cardiomyocytes were preincubated for 30 min and then superfused with control solution or solution containing ethanol. Ethanol had acute negative inotropic and positive lusitropic effects in human atrial muscle strips and murine ventricular cardiomyocytes. Accordingly, Ca2+-imaging indicated lower Ca2+-transient amplitudes and increased SERCA2a activity, while myofilament Ca2+-sensitivity was reduced. SR Ca2+-leak was assessed by measuring Ca2+-sparks. Ethanol induced severe SR Ca2+-leak in human atrial cardiomyocytes (calculated leak: 4.60 ± 0.45 mF/F0 vs 1.86 ± 0.26 in control, n ≥ 80). This effect was dose-dependent, while spontaneous arrhythmogenic Ca2+-waves increased ~5-fold, as investigated in murine cardiomyocytes. Delayed afterdepolarizations, which can result from increased SR Ca2+-leak, were significantly increased by ethanol. Measurements using the reactive oxygen species (ROS) sensor CM-H2DCFDA showed increased ROS-stress in ethanol treated cells. ROS-scavenging with N-acetylcysteine prevented negative inotropic and positive lusitropic effects in human muscle strips. Ethanol-induced Ca2+-leak was abolished in mice with knockout of NOX2 (the main source for ROS in cardiomyocytes). Importantly, mice with oxidation-resistant CaMKII (Met281/282Val mutation) were protected from ethanol-induced Ca2+-leak. CONCLUSION We show for the first time that ethanol acutely induces strong SR Ca2+-leak, also altering excitation-contraction coupling. Acute negative inotropic effects of ethanol can be explained by reduced systolic Ca2+-release. Mechanistically, ROS-production via NOX2 and oxidative activation of CaMKII appear to play central roles. This provides a mechanism for the arrhythmogenic and negative inotropic effects of ethanol and suggests a druggable target (CaMKII).
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Affiliation(s)
- Julian Mustroph
- Dept. of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Olivia Wagemann
- Dept. of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Simon Lebek
- Dept. of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Daniel Tarnowski
- Dept. of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Jasmin Ackermann
- Dept. of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Marzena Drzymalski
- Dept. of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Steffen Pabel
- Dept. of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Christof Schmid
- Dept. of Cardiothoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Stefan Wagner
- Dept. of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Samuel Sossalla
- Dept. of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Lars S Maier
- Dept. of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany
| | - Stefan Neef
- Dept. of Internal Medicine II, University Medical Center Regensburg, Regensburg, Germany.
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Mirijello A, Tarli C, Vassallo GA, Sestito L, Antonelli M, d'Angelo C, Ferrulli A, De Cosmo S, Gasbarrini A, Addolorato G. Alcoholic cardiomyopathy: What is known and what is not known. Eur J Intern Med 2017. [PMID: 28647343 DOI: 10.1016/j.ejim.2017.06.014] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Excessive alcohol consumption represents one of the main causes of non-ischemic dilated cardiomyopathy. Alcoholic cardiomyopathy is characterized by dilation and impaired contraction of one or both myocardial ventricles. It represents the final effect of alcohol-induced toxicity to the heart. Several pathophysiological mechanisms have been proposed at the basis of alcohol-induced damage, most of which are still object of research. Unfortunately, symptoms of alcoholic cardiomyopathy are not specific and common to other forms of heart failure and appear when dilatation and systolic dysfunction are consolidated. Thus, early diagnosis is mandatory to prevent the development and progression to heart failure. Although physicians are aware of this disease, several pitfalls in the diagnosis, natural history, prognosis and treatment are still present. The aim of this narrative review is to describe clinical characteristics of alcoholic cardiomyopathy, highlighting the areas of uncertainty.
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Affiliation(s)
- Antonio Mirijello
- Department of Medical Sciences, Hepatology and Gastroenterology Unit, Catholic University of Rome, Italy; Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy.
| | - Claudia Tarli
- Department of Medical Sciences, Hepatology and Gastroenterology Unit, Catholic University of Rome, Italy
| | - Gabriele Angelo Vassallo
- Department of Medical Sciences, Hepatology and Gastroenterology Unit, Catholic University of Rome, Italy
| | - Luisa Sestito
- Department of Medical Sciences, Hepatology and Gastroenterology Unit, Catholic University of Rome, Italy
| | - Mariangela Antonelli
- Department of Medical Sciences, Hepatology and Gastroenterology Unit, Catholic University of Rome, Italy
| | - Cristina d'Angelo
- Department of Medical Sciences, Hepatology and Gastroenterology Unit, Catholic University of Rome, Italy; "Gli Angeli di Padre Pio", Padre Pio Rehabilitation Centres Foundation, San Giovanni Rotondo, Italy
| | - Anna Ferrulli
- Department of Medical Sciences, Hepatology and Gastroenterology Unit, Catholic University of Rome, Italy
| | - Salvatore De Cosmo
- Department of Medical Sciences, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Antonio Gasbarrini
- Department of Medical Sciences, Hepatology and Gastroenterology Unit, Catholic University of Rome, Italy
| | - Giovanni Addolorato
- Department of Medical Sciences, Hepatology and Gastroenterology Unit, Catholic University of Rome, Italy
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Tu X, Wang C, Ru X, Jing L, Zhou L, Jing L. Therapeutic effects of rapamycin on alcoholic cardiomyopathy. Exp Ther Med 2017; 14:2763-2770. [PMID: 28966668 PMCID: PMC5613205 DOI: 10.3892/etm.2017.4901] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Accepted: 01/26/2017] [Indexed: 12/21/2022] Open
Abstract
The present study aimed to investigate whether rapamycin has therapeutic potential as a treatment for alcoholic cardiomyopathy. Rats were divided into eight groups (n=7 in each group): The control group; the alcohol group; abstinence in the first week; abstinence in the third week; abstinence in the fourth week; abstinent+rapamycin (AB-RAP) until the first week (AB-RAP 1); AB-RAP until the third week (AB-RAP 3); and AB-RAP until the fourth week (AB-RAP 4). Subsequently, echocardiography, and hematoxylin-eosin and Masson's staining were performed, followed by electron microscopy and terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling assay. Finally, expression levels of B cell lymphoma-2, Beclin-1 and microtubule-associated protein 1A/1B-light chain 3 were detected by immunohistochemistry and western blot analysis. The levels of left ventricular end-diastolic dimension in AB-RAP 3 (7.00±0.41) and AB-RAP 4 (6.33±0.68) groups were significantly lower when compared with the alcohol group (8.01±0.30; P<0.05). Compared with the alcohol group, the apoptosis rate of left ventricular myocardial tissue in the AB+RAP 3 (37.68±2.15) and AB+RAP 4 (26.97±2.11) groups was significantly reduced (P<0.05). To conclude, rapamycin may be considered as a therapeutic tool to attenuate alcoholic cardiomyopathy and improve cardiac function through increasing autophagy and reducing apoptosis.
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Affiliation(s)
- Xilin Tu
- Department of Emergency, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Chao Wang
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Xiaoxue Ru
- Department of Cardiology, Harbin Second Hospital, Harbin, Heilongjiang 150001, P.R. China
| | - Lili Jing
- Department of Medicine, Rangbei Hospital, Daqing Oilfield, Daqing, Heilongjiang 163114, P.R. China
| | - Lijun Zhou
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
| | - Ling Jing
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang 150001, P.R. China
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Abstract
Owing to its acute psychotropic effects, ethanol is the most frequently consumed toxic agent worldwide. However, excessive alcohol intake results in an array of health, social, and economic consequences, which are related to its property as an addictive substance. It has been well established that exposure to high levels of alcohol for a long period leads to the onset and progression of nonischemic cardiomyopathy through direct toxic mechanisms of ethanol and its metabolite, acetaldehyde. Excessive alcohol ingestion causes myocardial damage including disruptions of the myofibrillar architecture and is associated with reduced myocardial contractility and decreased ejection volumes. Key features of alcoholic cardiomyopathy are cardiac hypertrophy and ventricular dilatation, and the disease is manifested mainly as cardiomegaly, congestive heart failure, and even cardiac death. Mechanisms that have been postulated to underlie the pathogenesis of alcoholic cardiomyopathy include apoptosis, mitochondrial alterations, acetaldehyde protein adduct formation, oxidative stress, and imbalances in fatty acid metabolism. In the following, we give a brief overview of the molecular effects of ethanol-metabolizing enzymes and their impact on myocardial signal transduction pathways.
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Steiner JL, Lang CH. Etiology of alcoholic cardiomyopathy: Mitochondria, oxidative stress and apoptosis. Int J Biochem Cell Biol 2017; 89:125-135. [PMID: 28606389 DOI: 10.1016/j.biocel.2017.06.009] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 06/07/2017] [Accepted: 06/08/2017] [Indexed: 12/16/2022]
Abstract
Putative mechanisms leading to the development of alcoholic cardiomyopathy (ACM) include the interrelated cellular processes of mitochondria metabolism, oxidative stress and apoptosis. As mitochondria fuel the constant energy demands of this continually contracting tissue, it is not surprising that alcohol-induced molecular changes in this organelle contribute to cardiac dysfunction and ACM. As the causal relationship of these processes with ACM has already been established, the primary objective of this review is to provide an update of the experimental findings to more completely understand the aforementioned mechanisms. Accordingly, recent data indicate that alcohol impairs mitochondria function assessed by membrane potential and respiratory chain activity. Indictors of oxidative stress including superoxide dismutase, glutathione metabolites and malondialdehyde are also adversely affected by alcohol oftentimes in a sex-dependent manner. Additionally, myocardial apoptosis is increased based on assessment of TUNEL staining and caspase activity. Recent work has also emerged linking alcohol-induced oxidative stress with apoptosis providing new insight on the codependence of these interrelated mechanisms in ACM. Attention is also given to methodological differences including the dose of alcohol, experimental model system and the use of males versus females to highlight inconsistencies and areas that would benefit from establishment of a consistent model.
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Affiliation(s)
- Jennifer L Steiner
- Department of Cellular and Molecular Physiology, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, United States.
| | - Charles H Lang
- Department of Cellular and Molecular Physiology, Penn State College of Medicine, 500 University Drive, Hershey, PA 17033, United States.
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Rehm J, Hasan OSM, Imtiaz S, Neufeld M. Quantifying the contribution of alcohol to cardiomyopathy: A systematic review. Alcohol 2017; 61:9-15. [PMID: 28599715 DOI: 10.1016/j.alcohol.2017.01.011] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2016] [Revised: 12/21/2016] [Accepted: 01/20/2017] [Indexed: 02/07/2023]
Abstract
Alcohol has a direct toxic impact on the heart, and while there is an ICD code for alcoholic cardiomyopathy, the burden of alcohol-attributable cardiomyopathy is not clear. For the usual estimation of this burden via population-attributable fractions, one would need to determine the risk relationships, i.e., average risk associated with different dimensions of alcohol exposure. The most important among these risk relationships is the dose-response relationship with different levels of average alcohol consumption. To establish risk relationships, we systematically searched for all studies on dose-response relationships, directly and indirectly, via reviews. The results did not permit computation of pooled estimates through meta-analyses. There were clear indications that heavy drinking (≥80 g per day) over several years was linked to high risk of cardiomyopathy, with greater lifetime exposure of alcohol linked to higher risks. Some studies indicated potential effects of patterns of drinking as well. As such, the global quantification of alcohol-attributable cardiomyopathy will have to rely on other methods than those used conventionally.
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Xu R, Luo R, Tan B, Gan T, Li G. Early changes of left atrial function in chronic asymptomatic alcoholics by two-dimensional speckle-tracking echocardiography. Acta Cardiol 2017; 72:28-35. [PMID: 28597735 DOI: 10.1080/00015385.2017.1281548] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Chronic excessive alcohol intake has been reported as a possible cause of dilated cardiomyopathy. Two-dimensional speckle-tracking echocardiography (2D-STE) is a novel method for the angle-independent and objective quantification of myocardial deformation. This study sought to assess left atrial function changes among alcoholics related to the duration of heavy drinking by 2D-STE. Methods We classified 92 asymptomatic alcoholics into mild, moderate and severe groups. Thirty age-matched controls were also recruited. We measured left atrial (LA) phasic volumes (max, min and pre-atrial contraction volume) using Simpson's method in apical four-chamber view. Passive emptying (LAPEF) and active emptying (LAAEF) indices were calculated. Global longitudinal strain rate (SRs) during left ventricular (LV) ejection, early diastolic strain rate (SRe) during LV early diastole and peak negative strain rate (SRa) after the P-wave were also obtained by averaging all atrial segments. Results The alcoholics had larger LA volumes (max, min and pre-atrial contraction volume) since moderate stage (P < 0.01). LAPEF, SRs SRe, and E/A ratio showed progressive decrease according to the grades of alcoholism. The differences between the groups were significant, beginning from the moderate group (P < 0.01). During LAAEF, SRa values increased with the disease severity up to moderate alcoholics and then deteriorated significantly in severe alcoholics (P < 0.01). Conclusions These data suggest that 2D-STE may be considered a promising tool for the early detection of impairment of LA function in alcoholics.
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Affiliation(s)
- Rui Xu
- Department of Ultrasound, the Second Affiliated Hospital of Dalian Medical University, China
| | - Runlan Luo
- Department of Ultrasound, the Second Affiliated Hospital of Dalian Medical University, China
| | - Bijun Tan
- Department of Ultrasound, the Second Affiliated Hospital of Dalian Medical University, China
| | - Tian Gan
- Department of Ultrasound, the Second Affiliated Hospital of Dalian Medical University, China
| | - Guangsen Li
- Department of Ultrasound, the Second Affiliated Hospital of Dalian Medical University, China
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Berridge BR, Mowat V, Nagai H, Nyska A, Okazaki Y, Clements PJ, Rinke M, Snyder PW, Boyle MC, Wells MY. Non-proliferative and Proliferative Lesions of the Cardiovascular System of the Rat and Mouse. J Toxicol Pathol 2016; 29:1S-47S. [PMID: 27621537 PMCID: PMC5013710 DOI: 10.1293/tox.29.3s-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The INHAND Project (International Harmonization of Nomenclature and Diagnostic Criteria
for Lesions in Rats and Mice) is a joint initiative of the Societies of Toxicologic
Pathology from Japan (JSTP), Europe (ESTP), Great Britain (BSTP) and North America (STP)
to develop an internationally-accepted nomenclature for proliferative and
non-proliferative lesions in laboratory animals. The primary purpose of this publication
is to provide a standardized nomenclature for characterizing lesions observed in the
cardiovascular (CV) system of rats and mice commonly used in drug or chemical safety
assessment. The standardized nomenclature presented in this document is also available
electronically for society members on the internet (http://goreni.org). Accurate and
precise morphologic descriptions of changes in the CV system are important for
understanding the mechanisms and pathogenesis of those changes, differentiation of natural
and induced injuries and their ultimate functional consequence. Challenges in nomenclature
are associated with lesions or pathologic processes that may present as a temporal or
pathogenic spectrum or when natural and induced injuries share indistinguishable features.
Specific nomenclature recommendations are offered to provide a consistent approach.
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Affiliation(s)
| | | | - Hirofumi Nagai
- Takeda Pharmaceutical Co, Ltd, Fujisawa, Kanagawa, Japan
| | - Abraham Nyska
- Consultant in Toxicologic Pathology and Sackler School of Medicine, Tel Aviv University, Timrat, Israel
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Gardner JD. Alcohol binge drinking: getting to the heart of it. Am J Physiol Heart Circ Physiol 2016; 310:H1606-7. [PMID: 27208162 DOI: 10.1152/ajpheart.00368.2016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 05/12/2016] [Indexed: 01/02/2023]
Affiliation(s)
- J D Gardner
- Department of Physiology, School of Medicine, Louisiana State University Health Sciences Center, New Orleans, Louisiana
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Basuray A, Fang JC. Management of Patients With Recovered Systolic Function. Prog Cardiovasc Dis 2016; 58:434-43. [PMID: 26796969 DOI: 10.1016/j.pcad.2016.01.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Accepted: 01/10/2016] [Indexed: 11/25/2022]
Abstract
Advancements in the treatment of heart failure (HF) with systolic dysfunction have given rise to a new population of patients with improved ejection fraction (EF). The management of this distinct population is not well described due to a lack of consensus on the definition of myocardial recovery, a scarcity of data on the natural history of these patients, and the absence of focused clinical trials. Moreover, an improvement in EF may have different prognostic and management implications depending on the underlying etiology of cardiomyopathy. This can be challenging for the clinician who is approached by a patient inquiring about a reduction of medical therapy after apparent EF recovery. This review explores management strategies for HF patients with recovered EF in a disease-specific format.
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Guzzo-Merello G, Dominguez F, González-López E, Cobo-Marcos M, Gomez-Bueno M, Fernandez-Lozano I, Millan I, Segovia J, Alonso-Pulpon L, Garcia-Pavia P. Malignant ventricular arrhythmias in alcoholic cardiomyopathy. Int J Cardiol 2015; 199:99-105. [DOI: 10.1016/j.ijcard.2015.07.029] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 06/24/2015] [Accepted: 07/06/2015] [Indexed: 12/28/2022]
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Abstract
Alcoholic cardiomyopathy (ACM) is a specific heart muscle disease found in individuals with a history of long-term heavy alcohol consumption. ACM is associated with a number of adverse histological, cellular, and structural changes within the myocardium. Several mechanisms are implicated in mediating the adverse effects of ethanol, including the generation of oxidative stress, apoptotic cell death, impaired mitochondrial bioenergetics/stress, derangements in fatty acid metabolism and transport, and accelerated protein catabolism. In this review, we discuss the evidence for such mechanisms and present the potential importance of drinking patterns, genetic susceptibility, nutritional factors, race, and sex. The purpose of this review is to provide a mechanistic paradigm for future research in the area of ACM.
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Affiliation(s)
- Mariann R. Piano
- Professor and Department Head, Department of Biobehavioral Health Science (MC 807), University of Illinois at Chicago, 845 S. Damen Ave., Chicago, IL 60612, 312-413-0132 (TEL), 312-996-4979,
| | - Shane A. Phillips
- Associate Professor and Associate Department Head, Department of Physical Therapy, University of Illinois at Chicago, 1919 W. Taylor St. (MC 898), Chicago, IL 60612, 312-355-0277 (TEL),
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Natural history and prognostic factors in alcoholic cardiomyopathy. JACC-HEART FAILURE 2014; 3:78-86. [PMID: 25458176 DOI: 10.1016/j.jchf.2014.07.014] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 07/16/2014] [Accepted: 07/28/2014] [Indexed: 12/16/2022]
Abstract
OBJECTIVES This study sought to determine the natural history of contemporary alcoholic cardiomyopathy (ACM), to compare it with that of idiopathic dilated cardiomyopathy (IDCM), and to identify risk factors for poor outcome. BACKGROUND ACM is a common cause of dilated cardiomyopathy (DCM), but little is known about its natural history or the effect of reducing alcohol intake on disease progression. METHODS We studied the clinical characteristics and outcomes of 94 consecutive patients with ACM and 188 with IDCM, evaluated over the period between 1993 and 2011. RESULTS After a median follow-up of 59 months (interquartile range: 25 to 107 months), 14 ACM patients (15%) had died from cardiovascular causes (6 from heart failure and 8 from sudden cardiac death), 14 (15%) underwent heart transplantation, 35 (37%) experienced recovery in left ventricular function, and 31 (33%) remained clinically stable without improvement in systolic function. Transplantation-free survival was higher in ACM patients than in IDCM patients (p = 0.002), and ACM was associated with a favorable outcome on multiple analysis of the entire cohort (odds ratio [OR]: 0.4; 95% confidence interval [CI]: 0.2 to 0.8; p = 0.01). Independent predictors of death or heart transplantation in ACM identified by multiple logistic regression analysis were atrial fibrillation (OR: 9.7; 95% CI: 2.56 to 36.79; p = 0.001); QRS duration >120 ms (OR: 7.2; 95% CI: 2.02 to 26; p = 0.002), and lack of beta-blocker therapy (OR: 4.4; 95% CI: 1.35 to 14.49; p = 0.014). ACM patients who reduced their alcohol intake to moderate levels exhibited similar survival (p = 0.22) and cardiac function recovery (p = 0.8) as abstainers. CONCLUSIONS ACM has a better prognosis than IDCM. Atrial fibrillation, QRS width >120 ms, and the absence of beta-blocker therapy identify patients with a poor outcome. Alcohol abstainers and those who reduce intake to a moderate degree show similar clinical outcomes.
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Brinkley DM, Novak E, Topkara VK, Geltman EM. Graft Survival After Cardiac Transplantation for Alcohol Cardiomyopathy. Transplantation 2014; 98:465-9. [DOI: 10.1097/tp.0000000000000083] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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Bhattacharya-Ghosh B, Bozkurt S, Rutten MCM, van de Vosse FN, Díaz-Zuccarini V. An in silico case study of idiopathic dilated cardiomyopathy via a multi-scale model of the cardiovascular system. Comput Biol Med 2014; 53:141-53. [PMID: 25147131 DOI: 10.1016/j.compbiomed.2014.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 05/27/2014] [Accepted: 06/21/2014] [Indexed: 10/25/2022]
Abstract
Mathematical modelling has been used to comprehend the pathology and the assessment of different treatment techniques such as heart failure and left ventricular assist device therapy in the cardiovascular field. In this study, an in-silico model of the heart is developed to understand the effects of idiopathic dilated cardiomyopathy (IDC) as a pathological scenario, with mechanisms described at the cellular, protein and organ levels. This model includes the right and left atria and ventricles, as well as the systemic and pulmonary arteries and veins. First, a multi-scale model of the whole heart is simulated for healthy conditions. Subsequently, the model is modified at its microscopic and macroscopic spatial scale to obtain the characteristics of IDC. The extracellular calcium concentration, the binding affinity of calcium binding proteins and the maximum and minimum elastances have been identified as key parameters across all relevant scales. The modified parameters cause a change in (a) intracellular calcium concentration characterising cellular properties, such as calcium channel currents or the action potential, (b) the proteins being involved in the sliding filament mechanism and the proportion of the attached crossbridges at the protein level, as well as (c) the pressure and volume values at the organ level. This model allows to obtain insight and understanding of the effects of the treatment techniques, from a physiological and biological point of view.
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Affiliation(s)
| | - Selim Bozkurt
- Eindhoven University of Technology, Biomedical Engineering, Materials Technology, PO Box 513, GEM-Z 4.18, 5600 MB, Eindhoven, The Netherlands.
| | - Marcel C M Rutten
- Eindhoven University of Technology, Biomedical Engineering, Materials Technology, PO Box 513, GEM-Z 4.18, 5600 MB, Eindhoven, The Netherlands.
| | - Frans N van de Vosse
- Eindhoven University of Technology, Biomedical Engineering, Materials Technology, PO Box 513, GEM-Z 4.18, 5600 MB, Eindhoven, The Netherlands.
| | - Vanessa Díaz-Zuccarini
- University College London, Mechanical Engineering Department, Torrington Place, WC1E 7JE London, UK.
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Guzzo-Merello G, Cobo-Marcos M, Gallego-Delgado M, Garcia-Pavia P. Alcoholic cardiomyopathy. World J Cardiol 2014; 6:771-781. [PMID: 25228956 PMCID: PMC4163706 DOI: 10.4330/wjc.v6.i8.771] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Revised: 05/15/2014] [Accepted: 05/29/2014] [Indexed: 02/06/2023] Open
Abstract
Alcohol is the most frequently consumed toxic substance in the world. Low to moderate daily intake of alcohol has been shown to have beneficial effects on the cardiovascular system. In contrast, exposure to high levels of alcohol for a long period could lead to progressive cardiac dysfunction and heart failure. Cardiac dysfunction associated with chronic and excessive alcohol intake is a specific cardiac disease known as alcoholic cardiomyopathy (ACM). In spite of its clinical importance, data on ACM and how alcohol damages the heart are limited. In this review, we evaluate available evidence linking excessive alcohol consumption with heart failure and dilated cardiomyopathy. Additionally, we discuss the clinical presentation, prognosis and treatment of ACM.
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Givertz MM, Mann DL. Epidemiology and natural history of recovery of left ventricular function in recent onset dilated cardiomyopathies. Curr Heart Fail Rep 2014; 10:321-30. [PMID: 24014141 DOI: 10.1007/s11897-013-0157-5] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Although the long term prognosis of patients with dilated cardiomyopathy (DCM) remains poor, approximately 25 % of DCM patients with recent onset of heart failure (< 6 months) have a relatively benign clinical course with a spontaneously improvement in symptoms and partial, or in some cases complete, recovery of left ventricular (LV) function. Despite the longstanding recognition of the clinical phenomenon of LV recovery, relatively little attention has been paid to the etiology and natural history of this important group of DCM patients. Accordingly, in the present review we will focus on the epidemiology and natural history of recent onset DCM in patients who undergo spontaneous resolution of symptoms that is accompanied by recovery of LV function.
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Affiliation(s)
- Michael M Givertz
- Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
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46
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Yousaf H, Rodeheffer RJ, Paterick TE, Ashary Z, Ahmad MN, Ammar KA. Association between alcohol consumption and systolic ventricular function: a population-based study. Am Heart J 2014; 167:861-8. [PMID: 24890536 DOI: 10.1016/j.ahj.2014.02.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Accepted: 02/25/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Although moderate alcohol consumption is associated with decreased clinical heart failure, there are no population-based studies evaluating the relationship between alcohol consumption and left ventricular (LV) systolic function. We sought to evaluate the relationship between alcohol consumption and LV systolic function in the community. METHODS In a population-based random sample of 2,042 adults, age ≥45 years, we assessed alcohol consumption by a self-administered questionnaire. Responders were categorized by alcohol consumption level: abstainer, former drinker, light drinker (<1 drink a day), moderate drinker (1-2 drinks a day), and heavy drinker (>2 drinks a day). Systolic function was assessed by echocardiography. RESULTS We identified 38 cases of systolic dysfunction in 182 abstainers, 309 former drinkers, 1,028 light drinkers, 251 moderate drinkers, and 146 heavy drinkers. A U-shaped relationship was observed between alcohol consumption and moderate systolic dysfunction (LV ejection fraction [LVEF] ≤40%), with the lowest prevalence in light drinkers (0.9%) compared to the highest prevalence in heavy drinkers (5.5%) (odds ratio 0.14, 95% CI 0.04-0.43). This association persisted across different strata of risk factors of systolic dysfunction as well as in multivariate analysis. No significant association between alcohol consumption and systolic function was seen in subjects with LVEF >50% or ≤50%. CONCLUSIONS There is a U-shaped relationship between alcohol consumption volume and LVEF, with the lowest risk of moderate LV dysfunction (LVEF ≤40%) observed in light drinkers (<1 drink a day). These findings are parallel to the relationship between alcohol consumption and cardiovascular disease prevalence.
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Affiliation(s)
- Haroon Yousaf
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI
| | | | - Timothy E Paterick
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI
| | - Zain Ashary
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI
| | - Mirza Nubair Ahmad
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI
| | - Khawaja Afzal Ammar
- Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI.
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Sano F, Ohira T, Kitamura A, Imano H, Cui R, Kiyama M, Okada T, Yamagishi K, Sankai T, Tanigawa T, Kario K, Iso H. Heavy Alcohol Consumption and Risk of Atrial Fibrillation. Circ J 2014; 78:955-61. [DOI: 10.1253/circj.cj-13-1387] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Fumihiko Sano
- Public Health, Department of Social and Environmental Medicine, Osaka University, Graduate School of Medicine
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University
| | - Tetsuya Ohira
- Public Health, Department of Social and Environmental Medicine, Osaka University, Graduate School of Medicine
| | | | - Hironori Imano
- Public Health, Department of Social and Environmental Medicine, Osaka University, Graduate School of Medicine
| | - Renzhe Cui
- Public Health, Department of Social and Environmental Medicine, Osaka University, Graduate School of Medicine
| | - Masahiko Kiyama
- Osaka Center for Cancer and Cardiovascular Diseases Prevention
| | - Takeo Okada
- Osaka Center for Cancer and Cardiovascular Diseases Prevention
| | - Kazumasa Yamagishi
- Department of Public Health Medicine, Graduate School of Comprehensive Human Sciences, University of Tsukuba
| | - Tomoko Sankai
- Department of Public Health Medicine, Division of Health Innovation and Nursing, University of Tsukuba
| | - Takeshi Tanigawa
- Department of Public Health, Social Medicine and Medical Informatics, Ehime University, Graduate School of Medicine
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University
| | - Hiroyasu Iso
- Public Health, Department of Social and Environmental Medicine, Osaka University, Graduate School of Medicine
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Alcohol-Mediated Changes in Left Atrial Size in Coronary Heart Disease Patients. J Card Fail 2013; 19:190-2. [DOI: 10.1016/j.cardfail.2013.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2013] [Accepted: 01/28/2013] [Indexed: 11/23/2022]
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Quintana DS, McGregor IS, Guastella AJ, Malhi GS, Kemp AH. A Meta-Analysis on the Impact of Alcohol Dependence on Short-Term Resting-State Heart Rate Variability: Implications for Cardiovascular Risk. Alcohol Clin Exp Res 2012; 37 Suppl 1:E23-9. [DOI: 10.1111/j.1530-0277.2012.01913.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 06/04/2012] [Indexed: 11/26/2022]
Affiliation(s)
| | - Iain S. McGregor
- School of Psychology ; University of Sydney; Sydney; NSW; Australia
| | - Adam J. Guastella
- Brain and Mind Research Institute ; University of Sydney; Sydney; NSW; Australia
| | - Gin S. Malhi
- Discipline of Psychiatry; CADE Clinic ; Sydney Medical School-Northern; University of Sydney; Sydney; NSW; Australia
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Hookana E, Junttila MJ, Puurunen VP, Tikkanen JT, Kaikkonen KS, Kortelainen ML, Myerburg RJ, Huikuri HV. Causes of nonischemic sudden cardiac death in the current era. Heart Rhythm 2011; 8:1570-5. [DOI: 10.1016/j.hrthm.2011.06.031] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 06/21/2011] [Indexed: 11/17/2022]
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