However, very few studies have investigated the relationship between clinical characteristics and prognosis in ACM. Although some studies have detailed structural and functional damage in proportion to the amount of alcohol consumed during a patient’s lifetime24, a large majority of authors have discarded this theory21-23,25. Both the absence of a direct correlation and the theory of the existence of a threshold dose (above which some alcoholics develop ACM) require the presence of individual susceptibility to alcohol induced cardiac damage63.
- At the end of the first year, no differences were found among the non-drinkers, who improved by 13.1%, and among those who reduced consumption to g/d (with an average improvement of 12.2%).
- 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.
- The natural history and long-term prognosis studies of Gavazzi et al10 and Fauchier et al11 compared the evolution of ACM patients according to their degree of withdrawal.
Genetics in Secondary Forms of DCM
- Moreover, myofibrils showed a progressively distorted structure, resulting in a homogeneous mass.
- He recruited 48 patients admitted to hospital with cardiomegaly without a clear aetiology and severe alcoholism.
- Despite the key clinical importance of alcohol as a cause of DCM, little information has been published on the long-term outcome of patients with ACM in China.
From January 2013 to December 2016, we collected data of 290 patients with ACM referred for evaluation to the Department of Internal Medicine and Department of Cardiology in our institute RIMS, Ranchi. This study was a retrospective, observational study and a diagnosis of ACM was made in accordance to the definition provided in the European Society of Cardiology consensus document on the classification of cardiomyopathies. Furthermore, there are conflicting data among studies regarding the prognosis of the condition, with some showing overall mortality near 60% and others showing a mortality rate of only 19% (Table 1).
Alcohol intake in patients with cardiomyopathy and heart failure: consensus and controversy
- Future studies in ACM should also address this topic, which has important economic consequences.
- This section collects any data citations, data availability statements, or supplementary materials included in this article.
- This possibly reflects concomitant maladaptive coping behaviors and cocausation with depression precipitating alcohol use and vice versa.19 Rates of hypertension, however, have doubled from 30% to 60% over the studied timeframe.
- Comorbidities such as depression are often overlooked and many of these comorbidities could be potentially modifiable risk factors to help curb subsequent cardiovascular sequelae as a result of AC.
- In the second study, Gavazzi led a multicentre study in which, from 1986 to 1995, 79 patients with ACM and 259 patients with DCM were recruited10.
In contrast, an enlarged heart was found in only 1 of 25 subjects with moderate consumption (4%), in 6 of 105 very mild consumers (5.7%), and in 4.5% of non-drinking individuals. Unfortunately, it is well known that abstinence is difficult to achieve, and it is important to stress that alternative treatments are needed, including therapies to help with alcohol withdrawal, heart failure drugs, and other promising therapeutic approaches that focus on pathogenesis. Plots of Kaplan-Meier displaying the estimated survival probability according to three factors (A–C). (A) Kaplan-Meier plots displaying the estimated survival probability in groups categorised according to QRS duration. (B) Kaplan-Meier plots displaying the estimated survival probability in groups categorised according to LVEF. (C) Kaplan-Meier plots displaying the estimated survival probability in groups categorised according to CTP.
Cardiovascular risks and benefits of moderate and heavy alcohol consumption
While some consider that this toxin alone is able to cause such a disease18,19, others contend that it is just a trigger or an agent favouring DCM3,21,22. Indeed, the first account of the possible harmful effects of alcohol specifically on heart muscle was reported in alcoholic cardiomyopathy symptoms the latter half of the 19th century. Expressions referring to “the heart of a wine drinker in Tubingen” and particularly a “Munich beer heart” were used and known in Germany during this time13.
- In the first of these studies, Fauchier et al11 studied 50 patients with ACM and 84 patients with DCM between 1986 and 1997.
- In addition, to address selection bias further we also assessed death before recruitment from alcohol use, by examining effects on early deaths using a longevity design, as previously 21,22.
- Another study indicated a decrease in the general hospitalization rates in heart failure across all races over the past couple of years.17 These differences could be attributed to racial disparities in access to healthcare leading to different rates of utilization of healthcare services.
Study design:
Our study has several limitations due to the administrative nature of the database and reliance on accuracy of coding. However, these limitations are counterbalanced by the considerable sample size and absence of selection bias. The findings of our study are limited to index stay and cannot be extrapolated to postdischarge events. It is also likely that the actual rate of AC may be underestimated because of undercoding given that a number of patients would present as heart failure exacerbations, thereby altering code used. In addition to this, there is difficulty in actually making the diagnosis of AC itself clinically due to absence of specific diagnostic criteria and the need to rule out other causes of cardiomyopathy as well.
Conversely, the 3 subjects recording a less satisfactory evolution had persisted in their consumption of alcohol. It should be noted that a moderate drinker included in this latter group showed an improvement of his ejection fraction. In their autopsies, he described finding dilated cavities of the heart and fatty degeneration of the ventricular walls14. MR studies rely on the assumptions of instrumental variable (IV) analysis, i.e., relevance, independence and exclusion restriction. Relevance requires that the IV predicts the exposure, which was addressed by only using independent genome wide significant genetic predictors.
Even investigations revealed higher incidences of AF, AVB, increased QRS duration, reduced LVEF, increased LVESD and LVEDD in tribal group. All these findings point towards the fact that tribals are already in advanced stage of ACM by the time they seek medical advice, which ultimately leads to high mortality as substantiated in our study. Among tribal population, no differences between the survival and death groups were observed at the baseline in terms of age, sex, chest pain, basal crepts, orthopnoea, PND (paroxysmal nocturnal dyspnoea), JVP (jugular venous pressure), oedema and New York Heart Association (NYHA) classification.
