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RESUMEN Datos recientes muestran que el abuso crónico de alcohol puede conducir a disfunción cardiovascular, a partir de dosis de etanol tradicionalmente consideradas bajas, y que la aparición de arritmias, incluyendo la fibrilación auricular, aumenta aún en consumidores de alcohol moderados. Los otros mecanismos comunes del impacto negativo del etanol están relacionados con el desarrollo de hipertensión y su consecuencia directa, la hipertrofia, fibrosis y disfunción diastólica. Debido a que la probabilidad de reversibilidad del remodelamiento cardíaco depende de un diagnóstico temprano de disfunción cardíaca, se debería recomendar la aplicación más amplia de métodos nuevos y más sensibles de evaluación de la función miocárdica, incluyendo el strain longitudinal ventricular izquierdo y derecho, así como de los protocolos adaptados a la ecocardiografía de estrés.
ABSTRACT The recent data show that chronic overuse of alcohol may lead to cardiovascular dysfunction, starting from traditionally judged as low ethanol doses, and that the burden of arrhythmias, including atrial fibrillation, increases even in moderate alcohol consumers. The other common mechanisms of the disadvantageous impact of ethanol are related to the development of hypertension and its direct aftermath, hypertrophy, fibrosis, and diastolic dysfunction. Since the chance of the reversibility of cardiac remodeling depends on the early diagnosis of cardiac dysfunction, the wider application of novel and sensitive methods of myocardial function assessment, including longitudinal strain of the left and right ventricles, as well as the adapted protocols for stress echocardiography, should be recommended.
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OBJECTIVES@#To establish an electrophysiological model of alcoholic cardiomyopathy by inducing pluripotent stem cells (iPSCs) to differentiate into cardiomyocytes (iPSC-CM) in vitro.@*METHODS@#The human iPSC were expanded in vitro and differentiated into iPSC-CM. The iPSC-CM were divided into a blank control group, an alcoholic experiment group (according to the concentration of alcoholic, the alcoholic experiment was also divided into many subgroups), and a KN93 treatment group. Then the efficiency of iPSC differentiated to iPSC-CM was detected by immunofluorescence, the function of iPSC-CM was detected by cell counting kit-8 (CCK8) assay and lactate dehydrogenase (LDH) activity assay kit. The electrophysiological activity of iPSC-CM was monitored by real time cellular analysis (RTCA), the injury of iPSC-CM caused by alcohol was further verified by the mitochondrial membrane potential fluorescence probe JC-1 staining combined with RTCA analysis.@*RESULTS@#Compared with the blank control group, the different doses (25, 50, 100, 150, 200, 250, 300 mmol/L) of alcohol could significantly inhibit the proliferation of iPSC-CM in a dose-dependent manner (all <0.05). Compared with the blank control group, the activity of iPSC-CM was significantly reduced by 100 mmol/L alcohol, resulting in the increase of LDH release, the decrease of mitochondrial membrane potential, the amplitude and beating rate (all <0.05). Compared with the 100 mg/mL alcoholic experiment group, the KN93 treatment group significantly alleviated the damage of alcohol to iPSC-CM by blocking the necrotic apoptotic pathway, resulting in the decrease of LDH release, the increase of mitochondrial membrane potential, the amplitude and beating rate (all <0.05).@*CONCLUSIONS@#The electrophysiological model of alcoholic cardiomyopathy based on the differentiation of cardiomyocytes are successfully established, which can be used to study the electrophysiological activity and the molecular mechanism for relevant diseases, and it may provide a more reasonable and effective research tool for drug screening and clinical study.
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Humans , Cardiomyopathy, Alcoholic , Cell Differentiation , Electrophysiological Phenomena , Induced Pluripotent Stem Cells , Myocytes, CardiacABSTRACT
Objective To explore the influence of trimetazidine on left cardiac systolic function and plasma brain natriuretic peptide(BNP)in alcoholic cardiomyopathy.Methods 60 cases of alcoholic cardiomyopathy in our hospital from December 2014 to December 2015 were chosen to research,and they were divided into observation group and control group by random number table,30 patients in each group.The control group was treated with bisoprolol combined with strengthening heart,diuretic and other treatment,the observation group was treated with trimetazidine on the basis of routine treatment.Left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter (LVEDD),each sub output(CO)after 6 months'treatment were compared.Results LVEF of the observation group was from pre -treatment (34.8 ±5.4)% up to (47.4 ±5.5)%,LVEDD value (49.1 ±6.5)min and CO values (5.6 ±0.7)L/min were significantly better than the control group[(53.4 ±7.5)min,(4.9 ±0.7)L/min],the differences were statistically significant(t =2.373,3.873,all P <0.05).BNP level of the observation group after treatment was significantly lower than control group[(455.8 ±133.2)fmoL/mL vs (542.7 ±128.3)fmoL/mL,t =2.574,P <0.05)].The total effective rate of the observation group (96.67%)was higher than that of the control group (80%),and the difference between the two groups was significant (χ2 =13.09,P <0.05 ).Conclusion Alcoholic cardiomyopathy should pay attention to the daily scientific daily routine,take measure to quit smoking and alcohol.Trimetazidine could effectively improve the left ventricular systolic function,decrease the level of BNP,thus is worthy of clinical application.
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Introdução. A cardiomiopatia (CMP) e a insuficiência cardíaca (IC) são condições clínicas graves, com alta morbidade e mortalidade. A maior sobrevida dos pacientes com câncer aumenta a probabilidade da incidência de CMP e IC nos pacientes submetidos à quimioterapia (QT). Objetivos. Relatar caso de CMP alcoólica agravada pela QT para linfoma de Hodgkin. Relato do caso. Feminina, 50 anos, negra, com CMP alcoólica, teve diagnóstico de linfoma de Hodgkin após investigação de adenomegalia cervical. Após oito meses de QT com doxorrubicina (530 mg/m2), bleomicina e vinblastina, apresentou piora da classe funcional e descompensações frequentes. Houve decréscimo importante da fração de ejeção ventricular esquerda, sucessivas internações por descompensação e evolução da paciente para classe funcional IV da New York Heart Association e estágio D do American Heart Association/American College of Cardiology. Conclusão. A cardiotoxicidade pelas antraciclínicos acontece mais frequentemente nos indivíduos com fatores predisponentes. Todo e qualquer agravo prévio ao miocárdio é risco para CMP. No caso relatado é plausível que a CMP alcoólica teve seu curso clínico agravado pela QT.
Background. Cardiomyopathy (CMP) and heart failure (HF) are severe clinical conditions, both with high morbidity and mortality rates. The longer life expectancy of patients with cancer (CA) increases the risks of developing CMP and HF. Objectives. Report cases of alcoholic CMP aggravated by chemotherapy (CT) for Hodgkin's lymphoma. Case Report.Female, 50 years old, black with CMP alcoholic, was diagnosed with Hodgkin's lymphoma after screening of cervical adenomegaly. After eight months of CT with doxorubicin (530 mg/m2), bleomycin and vinblastine, showed worsening of functional class and frequent decompensation. There was a significant decrease in left ventricular ejection fraction, successive hospitalizations for decompensation and evolution to New York Heart Association (NYHA) functional class IV and stage D of the American Heart Association/American College of Cardiology. Conclusion. Theanthracyclinecardiotoxicityoccurs morefrequently inpatients with predisposing factors.Anypreviousinjuryto the myocardiumisrisk toCMP due to CT.In this case it is probable that the alcoholic CMP had clinical course aggravated by CT.
Introducción. La miocardiopatía (MCP) y la insuficiencia cardíaca (IC) son situaciones clínicas graves con una alta morbilidad y mortalidad. La mayor sobrevida de los pacientes con cáncer aumenta la probabilidad de incidencia de MCP e IC en pacientes sometidos a quimioterapia (QT). Objetivos. Se presenta el caso de una MCP alcohólica agravada por la administración de quimioterapia para linfoma de Hodgkin. Caso clínico. Mujer de 50 años de edad, raza negra con MCP alcohólica, fue diagnosticada con linfoma de Hodgkin después de una linfadenopatía cervical. Después de ocho meses de QT con doxorrubicina (530mg/m2), bleomicina y vinblastina, presentó un empeoramiento de la clase funcional y descompensaciones frecuentes. Hubo una disminución significativa en la fracción de eyección del ventrículo izquierdo, sucesivas internaciones por descompensación de su IC y evolución de la paciente a clase funcional IV de la New York Heart Association y estadio D de American Heart Association/American College of Cardiology. Conclusión. La cardiotoxicidad por antraciclinas acontece con más frecuencia en personas con factores predisponentes. Cualquier injuria previa al miocardio presenta el riesgo de evolucionar a una MCP. En nuestro caso, es posible que la MCP alcohólica presentara una evolución clínica agravada por QT.
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A 62-year-old man had suffered from massive pedal edema, dyspnea and sinus bradycardia for 10 days. He had been heavy drinker for over 20 years. He was transferred to our hospital with severe heart failure. Echocardiography showed severe diffuse hypokinesis of left ventricular wall motion (EF20%) with dyssynchrony, and thrombus in the left ventricular apex. Under a diagnosis of LV thrombus due to severe heart failure, we made a plan for an emergency open heart surgery, but it could not be performed because of initial cardiogenic embolic stroke. Therefore, we waited for 2 weeks while performing anticoagulation therapy. The removal of LV thrombus and atrio-biventricular pacing for heart failure due to dyssynchrony were performed 2 weeks later. The pathological specimen of myocardium showed marked fibrous and hypertrophic change, which were similar to idiopathic dilated cardiomyopathy. Alcoholic cardiomyopathy due to alcohol intake for many years is similar to a clinical image of dilated cardiomyopathy, but its clinical prognosis by abstinence is not bad. In this case we performed an urgent open heart surgery due to cardiogenic embolic stroke, but must be essentially performed as an emergency operation. Postoperative course was uneventful and he was discharged 21 days after open heart surgery without any complications.
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Mitochondrial aldehyde dehydrogenase(ALDH2),one of the isoforms of aldehyde dehydrogenase,has multiple enzymatic functions including the activity of dehydrogenase and esterase.The metabolisms of ethanol,amino acids,biogenic amine,vitamin or steroid in the body produce various substances of aldehyde.With the help of co-factor NAD(P)+,ALDH2 can convert aldehydes into corresponding carboxylic acid,which plays a key role in reducing toxic effects of aldehydes on the body.It does not need co-factor when ALDH2 works as esterase.It can convert carboxylic ester or other acids into corresponding carboxylic acids or alcohols.Recently,it has been shown that the decrease of ALDH2 activity exacerbates multiple factors(such as ethanol,ischemia)-induced myocardial injury and accelerates the development of nitroglycerin tolerance.Therefore,the development of specific agonists of ALDH2 may provide a novel approach to the therapy and prevention of heart diseases.
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@# Objective To analyse the diagnosis characteristics of the aged and non-aged patients with dilated cardiomyopathy (DCM).Methods 192 inpatients suspected DCM from 2004 to 2006 were analysed retrospectively, as the groups of the aged (≥60 y) and non-aged (<60 y). Results The percentage of the aged group with idiopathic dilated cardiomyopathy (IDCM) or ischemic cardiomyopathy (ICM) was obviously higher than that of the non-aged group (P<0.01 and P<0.05, respectively). The percentage of the non-aged group with alcoholic cardiomyopathy (ACM) or viral cardiomyopathy (VCM) was higher than that of the aged group(P<0.01). Conclusion There are various diseases similar to DCM should be identified. The causes leading to DCM are different in the aged and non-aged patients.
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BACKGROUND AND PURPOSE OF THE RESEARCH: It is believed that a long-term drinking will be one of the causes of congestive cardiomyopathy (CM). It is also possible for diagnosis of alcoholic cardiomyopathy in the majority of the patients diagnosed as idiopathic dilated cardiomyopathy if the history of mass alcoholic drinking is taken into consideration or proper blood test is conducted. This study is to confirm whether there is an improvement in the clinical result and cardiac function as has so far been known the case in the patients suspected of alcoholic. METHODS: Among 39 patients with dilated CM who were diagnosed by echocardiographic criteria and clinical evaluation, 11 patients who drank more than 77 g of alcoholic everyday for more than 10 years were defined as alcoholic CM. The changes of their clinical manifestations and m-mode echocardiographic findings in the patients with alcoholic CM were compared before and after treatment. RESULTS: All studied patients were male with the mean age of 52.6+8.0 and the mean follow up period was 38.6 months. Of the 11 patients, 3 patients could not completely free themselves from drinking. Their symptoms on first visit ranged in such order as dyspnea (63.6%), tachycardia (54.5%), and generalized edema (27.3%). Following the treatment, dyspnea and tachycardia showed a statistically significant improvement. Echocardio-graphic parameters, ie, LV diastolic dimension (6.7+/-0.6 cm before treatment and 6.3+/-1.2 cm after treatment), LV systolic dimension (5.6+/-0.7 cm before treatment and 5.2+/-1.4 cm after treatment) and E point septal separation (13.6+/-9.6 mm before treatment and 10.9+/-6.6 mm after treatment) decreased after treatment without a significant meanings in a statistical view point. Their ejection fraction (29.6+/-6% before treatment and 34.5+/-11.1% after treatment) increased after treatment. CONCLUSION: Cardiac symptoms of congestive heart failure and echo-cardiographic parameters in patients with alcoholic CM were improved after abstinence from alcoholic ingestion and medical treatment.