Ethanol and heart disease. An underestimated contributing factor

Risk Factors in Alcoholic Cardiomyopathy

Although a relationship has been suggested between abstinence from alcohol and improvement in left ventricular (LV) function, no long-term studies in large groups of patients have been done to confirm this impression or to demonstrate an effect on survival. To address these questions, the authors analyzed the out come in 105 male patients with alcoholic cardiomyopathy and 64 control male patients with nonalcoholic dilated cardiomyopathy. Survival data were available for all patients. The correlates of survival were assessed via the Cox propor tional hazards model. Variables considered were age, race, drinking pattern (current drinker versus former drinker), presence of coronary artery disease (CAD), hypertension, and diabetes, and these echo variables: left atrial (LA) size, posterior wall thickness, LV end diastolic dimension (LVDD), minimal E point septal separation, wall motion, presence of incomplete mitral leaflet clo sure (IMLC) or low cardiac output, and the ratio of relative wall thickness to LVDD. The two study groups were comparable with respect to all echocardio graphic variables. At a mean follow-up of 17.2 months ± 12.1 months, 42.85% of the alcoholics and 41% of the nonalcoholics had died. Nonsurvival in the alcoholic group was significantly associated with only two factors: an increased LVDD and the presence of IMLC. The drinking pattern was not significantly associated with survival. By contrast, in the nonalcoholics, the variables most closely related to survival were LVDD, low cardiac output, increasing age, and abnormal wall motion. Therefore: (1) the risk factors in alcoholic and nonalco holic cardiomyopathy are similar although IMLC appears to be a relatively specific prognostic factor for alcoholic cardiomyopathy and (2) abstinence from alcohol does not appear to improve survival.

Diethylene glycol (DEG)-associated myocardial changes: a pilot investigation of chronic intoxication in guinea-pigs

The myocardium of guinea pigs fed on sublethal doses of diethylene glycol (DEG) over a period of 2-11 days was examined for microscopical and ultrastructural changes. Coagulative myocytolysis and loss of myofibrils, not observed in the controls, was patchily distributed throughout the myocardium. The accompanying ultrastructural features included swelling, pleomorphism and hyperplasia of mitochondria with an associated distension of the interfibrillary spaces and a displacement, distortion and rupture of adjacent myofibrils.

The challenge of cardiomyopathy

The combined clinical and pathophysiologic characteristics and diagnostic features as well as current concepts of pathogenesis, therapy and prevention of the principal forms of cardiomyopathy are reviewed. These include hypertrophic cardiomyopathy, dilated cardiomyopathy, restrictive cardiomyopathy and specific cardiac muscle disease. Emphasis is placed on recent developments and unresolved questions requiring application of newer techniques of molecular biology and genetics and adult myocyte culturing.

Alcohol and dilated cardiomyopathy: incidence and correlation with clinical outcome

Among a group of 28 elderly veterans with dilated cardiomyopathy regularly attending an outpatient heart failure clinic, half had a history of habitual heavy drinking. It was concluded that chronic heavy drinking was the only identifiable factor responsible for the heart failure in three of these patients. Eleven other patients also had chronic heavy drinking as a possible etiological factor of their heart failure in addition to Coronary Artery Disease and/or hypertension. Less than 50% of the heavy drinkers totally abstained from alcohol after seeking medical treatment although they reduced their drinking significantly. All three patients with clear alcoholic cardiomyopathy discontinued drinking and showed marked improvement in cardiac status. The discontinuation of drinking did not appear to be associated with improvement in the remaining heavy drinkers and those patients who reported a history of moderate drinking.