A method for establishing the electrophysiological model of alcoholic cardiomyopathy / 中南大学学报(医学版)

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.

Research Progress and Forensic Identification of Alcoholic Cardiomyopathy / 法医学杂志

With the rapid development of the social economy in China, the incidence of diseases caused by excessive drinking is gradually increasing as well. Alcoholic cardiomyopathy refers to long-term high intake of ethanol, and has typical dilated cardiomyopathy characteristics, such as, hemodynamic changes, symptoms, signs, and morphological features. It is a kind of cardiomyopathy that excludes other causes of dilated cardiomyopathy. Due to the lack of specific pathological changes, the forensic pathological identification of alcoholic cardiomyopathy can only be based on the patient's medical history and by ruling out other causes of cardiomyopathy. This paper reviews the pathogenesis and forensic identification of alcoholic cardiomyopathy in order to provide reference for forensic pathologists and clinicians.

Disfunción cardiaca en la cirrosis hepática / Cardiac dysfunction in liver cirrhosis

Objetivo: determinar las alteraciones de la función cardiaca en las personas que padecen cirrosis hepática. Métodos: se desarrolló un estudio descriptivo transversal en el Instituto de Gastroenterología durante el período 2011-2012, en 33 cirróticos de causa viral y alcohólica, 57,6 por ciento del sexo masculino, con una edad promedio de 50 años, la mayoría (84,8 por ciento) tenía la enfermedad compensada. Resultados: la disfunción diastólica fue la alteración cardiaca más frecuente (39,3 por ciento) seguida de la prolongación del intervalo QT (12,1 por ciento), disfunción sistólica (6,1 por ciento) y miocardiopatía cirrótica (3 por ciento). No se identificaron rasgos distintivos epidemiológicos y/o clínicos que caracterizara a estos pacientes. La circulación hiperdinámica fue más evidente en los que presentaron disfunción diastólica y en la cirrosis de origen alcohólico; las dimensiones cardiacas fueron normales en todos los casos. Conclusiones: las personas que padecen cirrosis son susceptibles de presentar alteraciones de la función cardiaca, incluso, desde la etapa compensada de la enfermedad, lo que debe considerarse por las implicaciones terapéuticas que demanda este tipo de paciente...

Objective: to determine abnormalities of cardiac function in subjects with liver cirrhosis. Methods: a descriptive cross-sectional study was conducted at the Institute of Gastroenterology from 2011 to 2012, in 33 cirrhotic patients due to alcoholic and viral causes, 57.6 percent male, with an average age of 50 years, most (84,8 percent) had compensated disease. Results: diastolic dysfunction was the most common cardiac disorders (39.3 percent) followed by QT prolongation (12.1 percent), systolic dysfunction (6.1 percent) and cirrhotic (3 percent) cardiomyopathy interval. No distinctive epidemiological and/or clinical studies were identified to characterize these patients. The hyperdynamic circulation was more evident in those presenting diastolic dysfunction and alcohol-related cirrhosis. Cardiac dimensions were normal in all cases. Conclusions: people with cirrhosis are susceptible to alterations in cardiac function, even from the compensated stage of the disease, which should be considered by the therapeutic implications of this type of patient demand...

The application of isoprenaline provocation test on rat model of alcoholic cardiomyopathy / 中国应用生理学杂志

<p><b>OBJECTIVE</b>To study a simple and reliable method to produce the rat model of alcoholic cardiomyopathy, evaluating the model with isoprenaline provocation test (IPT) and morphological indicators.</p><p><b>METHODS</b>Adult male rats were intragastrically infused of wine (52% v/v) at 20 g/(kg x d) for 15 days with the general condition, the change of eating amount and weight being observed. The levels of mean left ventricle systolic pressure (mLVSP), mean left ventricle diastolic pressure (mLVDP), mean left ventricle pressure (mLVP), heart ratio (HR), maximal rise velocity of left ventricular pressure (+ dp/dtmax), maximal fall velocity of left ventricular pressure (- dp/dtmax) and the reaction of isoprenaline were examined by left ventricular cannulation, and the morphological change was observed with optical microscope and transmission electron microscopy.</p><p><b>RESULTS</b>Both diastolic and systolic function of the model rats was lower than that of the control group as well as the cardiac energy reserve induced by IPT. Pathological observation demonstrated myocardial hypertrophy, myocardiocyte necrosis and infiltration of inflammatory cells. The transmission electron microscopy showed that mitochondria became enlarged or crimpled with fused or disappeared cristae and myofibrils dissolved and fractured.</p><p><b>CONCLUSION</b>The adult male SD model rats exhibit diabetic cardiomyopathy by intragastric infusion of wine (52% v/v) at 20 g/(kg x d) for 15 days. IPT can induce the cardiac energy reserve and evaluate that accurately, displaying the hidden heart dysfunction.</p>

Tenascin-x facilitates myocardial fibrosis and cardiac remodeling through transforming growth factor-β1 and peroxisome proliferator-activated receptor γ in alcoholic cardiomyopathy / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Tenascin-x, an extracellular matrix glycoprotein exclusively expressed in fibroblasts, can mediate fibrosis in the presence of collagen. Therefore, we have investigated its potential role in facilitating myocardial fibrosis and cardiac remodeling via the transforming growth factor-β1 and peroxisome proliferator-activated receptor γ (TGFβ(1)-PPARγ) pathway in alcoholic cardiomyopathy (ACM).</p><p><b>METHODS</b>Experimental animals were divided into control (group A) and tenascin-x knock-out groups (group B) receiving alcohol. Six months post treatment, cardiac ejections fraction (EF), fractional shortening (FS), left ventricle end-diastole internal diameter (LVEDd) and collagen column fraction (CVF) were observed. Tenascin-x, smad-3, TGFβ(1), smad-7 and PPARγ protein expression levels were detected by Western blotting.</p><p><b>RESULTS</b>Six months post treatment, EF and FS values were higher in group B than in group A (P < 0.05 and P < 0.01, respectively), while LVEDd and CVF were lower in group B (P < 0.05 and P < 0.01, respectively). Tenascin-x, smad-3 and TGFβ(1) protein expression levels were higher in group A, while smad-7 and PPARγ levels were lower than in group B (P < 0.01), as measured by immunohistochemistry and Western blotting. Tenascin-x protein expression was negatively correlated with EF, FS, smad-7 and PPARγ, and positively correlated with LVEDd, CVF, smad-3, and TGFβ(1) (P < 0.001).</p><p><b>CONCLUSION</b>Tenascin-x is an initiator of myocardial fibrosis and ACM development via upregulation of TGFβ(1) and downregulation of PPARγ.</p>

Effect of puerarin in myocardial protection in rats with acute and chronic alcoholism / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the protective effect of puerarin on the myocardium of rats with acute and chronic alcoholism.</p><p><b>METHODS</b>In acute alcoholism experiment, normal male SD rats were randomly divided into the control group, alcoholism group and puerarin group (n=8), and high- and low-dose puerarin was administered. In chronic alcoholism experiment, increasing puerarin doses were given. Serum and myocardial levels of spartate aminotransferase (AST) and creatine phosphokinase (CPK) were determined using enzymatic methed, and superoxide dismutase (SOD), malondialdehyde (MDA), Ca(2+)-Mg(2+)-ATPase, and Na(+)-K(+)-ATPase in the myocardium were assayed with colorimetric method. HE staining was used to observe the microscopic changes of the myocardium.</p><p><b>RESULTS</b>Compared with alcoholism group, puerarin-treated groups showed significantly lowered myocardial contents of MDA, CPK and AST and serum levels of AST and CPK (P<0.05, P<0.01) and increased myocardial SOD (P<0.05, P<0.01), Na(+)-K(+)-ATPase and Ca(2+)-Mg(2+)-ATPase activity (P<0.05, P<0.01), but Na(+)-K(+)-ATPase was similar between the two groups (P>0.05). HE staining of the myocardium showed cell swelling and obscure cell boundaries in alcoholism group, especially in chronic alcoholism group. The myocardial structure in puerarin group remained clear and regular.</p><p><b>CONCLUSION</b>Puerarin can protect from myocardial injuries induced by acute and chronic alcoholism in rats.</p>

Effect of valsartan and carnitine on cardiomyocyte Calpain-1 and Bcl-xl expressions of dogs with chronic alcohol intake-induced cardiomyopathy / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the effects of valsartan and carnitine on cardiomyocyte Calpain-1 and Bcl-xl expressions of dogs with chronic alcohol intake-induced cardiomyopathy.</p><p><b>METHODS</b>Dogs were randomly assigned into 4 groups (n = 7 each): (1) alcohol fed (free access to 5%, 1(st) week; 10% 2(nd) week; 500 ml 25% bolus plus free access to 5% from 3 to 24 weeks, A); (2) alcohol + valsartan (5 mg×kg(-1)×d(-1), B); (3) alcohol + carnitine (300 mg×kg(-1)×d(-1), C); (4) Control (D). After six months, all animals were assessed for left ventricular (LV) function by echocardiography. The Bad and Bcl-xl protein expressions were evaluated by immunohistochemistry. The expression of Calpain-1 protein was determined with Western blot. Myocardial morphology was quantified on HE stained slices and under electron microscopy. The terminal deoxynucleotidyl transferase-mediated nick end-labeling (TUNEL) was performed for apoptosis analysis.</p><p><b>RESULTS</b>Compared with group D, LVEDD and LVESD were significantly increased while EF and FS significantly decreased in group A. In alcohol fed group, expressions of Bad and Calpain-1 protein were significantly increased while Bcl-xl protein expression was downregulated, all changes could be significantly attenuated by intervention with valsartan and carnitine (all P < 0.05).</p><p><b>CONCLUSION</b>These data suggest that alcohol could promote cardiac myocyte apoptosis, reduce cardiac function and aggravate myocardial remodeling which valsartan and carnitine could reduce alcoholic cardiomyopathy by downregulating Calpain-1 and Bad protein expression and upregulating expression of Bcl-xl protein.</p>

Peroxisome proliferator-activated receptor alpha and retinoid X receptor alpha expressions and intervention in alcoholic cardiomyopathy rats / 中华心血管病杂志

<p><b>OBJECTIVE</b>To investigate the effects of carnitine on cardiac function, collagen contents, peroxisome proliferator-activated receptor alpha (PPARalpha) and retinoid X receptor alpha (RXRct) expressions in a rat alcoholic cardiomyopathy modeL.</p><p><b>METHODS</b>Adult male Wistar rats were randomly divided into alcohol group (A) , alcohol/carnitine group (B) and control group. Six months later, protein expressions of collagen I, collagen III, matrix metalloproteinase-9 (MMP-9) and Smad-3 were determined by immunohistochemical staining. Protein expressions of PPARalpha and RXRalpha were detected by Western blot.</p><p><b>RESULTS</b>Expressions of collagen I, collagen III, MMP-9 and Smad-3 were significantly increased in groups A and B compared to group C (P < 0.01 or P < 0.05). Expressions of PPARalpha and RXRalpha (0.156 and 0.192, respectively, in group A; 0.248 and 0.385, respectively, in group B) were decreased compared to group C (P < 0.01 or P < 0.05). These changes were significantly attenuated by carnitine (all P < 0.05, group B vs. group A). Moreover, PPARalpha and RXRalpha positively correlated with EF and FS, and negatively correlated LVEDd, collagen I , collagen III, MMP-9 and Smad-3 (all P < 0.01).</p><p><b>CONCLUSION</b>PPARalpha and RXRalpha downregulation is significantly correlated with cardiac dysfunction in this alcoholic cardiomyopathy model, carnitine ameliorated the cardiac fibrosis and remodeling possibly through upregulating the metabolic pathways of PPARalpha and RXRalpha.</p>

Alcoholic cardiomyopathy: clinical and molecular findings

It has been known for some decades that chronic alcoholism can lead to dilated cardiomyopathy. Although excessive drinking is known to result in alcoholic cardiomyopathy and light-to-moderate drinking may confer some cardiovascular benefits, recent studies suggest that it is not only the quantity, but also drinking patterns and genetic factors, that may influence the relation between alcohol consumption and cardiovascular disease. Alcoholic patients consuming > 90g of alcohol a day for > 5 years are at risk for the development of asymptomatic alcoholic cardiomyopathy. Those who continue to drink may become symptomatic and develop signs and symptoms of heart failure. We summarize the experimental and clinical evidence regarding the role of alcohol in pathophysiology of alcoholic cardiomyopathy

Role of renin-angiotensin system, PPARalpha, PPARgamma in the development of alcoholic cardiomyopathy / 中华心血管病杂志

<p><b>OBJECTIVE</b>To explore the time course of renin-angiotensin system (RAS), peroxisome proliferator-activated receptor (PPAR) alpha and PPARgamma change in an animal model of alcoholic cardiomyopathy (ACM).</p><p><b>METHODS</b>Adult rats were divided into three groups: ACM group (A, 10% alcohol as drinking water plus 5 ml 60% alcohol.kg(-1).d(-1) per gavage in the 1st week; 10% alcohol as drinking water plus 10 ml 60% alcohol/kg bid per gavage in the 2nd week, 20% alcohol as drinking water plus 15 ml 60% alcohol/kg bid per gavage during week 3 to week 16), ACM/ARB group(B, A + Irbesartan 5 mg.kg(-1).d(-1) per gavage) and control group (C). mRNA expressions and activities of renin, angiotensin, ACE and AT1 were detected with RT-PCR and radioimmunoassay methods. Protein expressions of PPARalpha and PPARgamma were determined with Western blot. Echocardiogram, optic (HE) and electron microscope examinations were also performed. Parameters were obtained at 2 or 6 months (n = 7 - 10 each).</p><p><b>RESULTS</b>Compared with group C, LV/BW ratio was significantly increased and LVEF significantly decreased, activities and expressions of Ang I, Ang II and renin were gradually increased, protein expressions of PPARalpha were gradually decreased at 2 and 6 months in group A (all P < 0.05). These changes could be partly attenuated by Irbesartan.</p><p><b>CONCLUSION</b>Activated RAS and decreased protein expressions of PPARalpha and PPARgamma contributed to the development of ACM.</p>

Study of oxidative stress and trace element levels in patients with alcoholic and non-alcoholic coronary artery disease.

Alcohol consumption induces oxidative stress, and leads to lipid peroxidation. These effects have been linked to alcohol-related toxicity and diseases are considered relevant to alcohol-atherosclerosis interrelationship. Deficiency of many antioxidants and trace elements may impair the antioxidant defense leading to ethanol induced oxidative stress. In the present study, our aim was to investigate the lipid peroxidation, lipid profile, antioxidant enzymes and trace elements in patients with and without alcoholic coronary artery disease (CAD). Our study included 61 patients suffering from CAD, 124 patients suffering from alcoholic CAD with high to moderate alcohol intake, 75 controls were randomly selected for our study. Increased serum lipid peroxidation, total cholesterol, triglycerides, LDL cholesterol and copper levels were high while levels of HDL cholesterol, glutathione peroxdiase, superoxide dismutase, trace elements like Selenium and Zinc were low in high alcoholic CAD patients compared with moderate and non alcoholic CAD patients. The results obtained from present study indicate that high alcohol intake predicts low antioxidant enzyme and that trace element may contribute to the increased susceptibility for the development of CAD.

Clinicopathologic analysis of dilated heart in cardiac transplant recipients / 中华病理学杂志

<p><b>OBJECTIVE</b>To study the pathologic features of dilated heart in cardiac transplant recipients, with clinicoradiologic correlation.</p><p><b>METHODS</b>Sixty recipient hearts from cardiac transplantation performed in Fuwai Hospital were analyzed by gross examination, histologic observation and electron microscopy. Clinicoradiologic correlation was available in 40 cases.</p><p><b>RESULTS</b>Amongst the 40 cases of dilated heart, 52.5% (21/40) were due to dilated cardiomyopathy, 22.5% (9/40) due to arrhythmogenic right ventricular cardiomyopathy, 15.0% (6/40) due to ischemic cardiomyopathy, and the remaining 10.0% (4/40) due to miscellaneous causes, including local noncompaction of ventricular myocardium, giant cell myocarditis, alcoholic cardiomyopathy and hypertensive cardiomyopathy. The discrepancy rate between clinical and pathologic diagnosis was 37.5% (15/40). The erroneous categories included arrhythmogenic right ventricular cardiomyopathy (7 cases), ischemic cardiomyopathy (5 cases), and giant cell myocarditis (1 case), which were all mistaken clinically as dilated cardiomyopathy. While ischemic cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy, noncompaction of ventricular myocardium and giant cell myocarditis have distinctive pathologic features, the diagnosis of alcoholic and hypertensive cardiomyopathies required clinicopathologic correlation. Dilated cardiomyopathy due to viral myocarditis was not identified in the cases studied.</p><p><b>CONCLUSION</b>Pathologic examination is essential in analysis of transplant recipient heart and helps to rectify clinical diagnostic discrepancy.</p>

Clinical Fate of Reversible Non-Ischemic Left Ventricular Systolic Dysfunction and Its Influencing Factors

BACKGROUND AND OBJECTIVES: About 25% of the patients with non-ischemic left ventricular (LV) systolic dysfunction will improve spontaneously. However, little has been known about the fate of the patients stricken with heart failure after recovery from LV dysfunction. We hypothesized that the patients who recovered from non-ischemic LV dysfunction have a substantial risk for recurrent heart failure. SUBJECTS AND METHODS: Fifty patients (32 males, mean age: 54.9+/-12.4 years) who recovered from systolic heart failure (LV ejection fraction; an EF of 28.8+/-7.2% at the initial presentation) to near-normal (LVEF > 40% and a 10% or more increase in the absolute value) were monitored for the recurrence of heart failure. Patients with significant coronary artery disease were excluded. The etiologies of heart failure were idiopathic dilated cardiomyopathy (n=39), alcoholic cardiomyopathy (n=7), adriamycin-induced cardiomyopathy (n=2), and tachycardia-induced cardiomyopathy (n=2). After recovery of LV dysfunction, the patients were followed up for a mean of 41.0+/-26.3 months. RESULTS: In 9 patients (18%), the LV systolic dysfunction recurred during follow-up (LVEF 32.6+/-7.3%). There was no significant difference in the baseline clinical and echocardiographic variables between the patients with and without recurrent heart failure. However, cessation of anti-heart failure medication was more frequently observed in the patients with recurrent LV systolic dysfunction (55.6% vs 4.9%, respectively, p<0.05). CONCLUSION: Recurrent heart failure may ensue in the patients with reversible non-ischemic LV systolic dysfunction. The maintenance of anti-heart failure medication in these patients may be a significant influencing factor for their clinical prognosis.

Estudo histomorfométrico da fibrose periarteriolar miocárdica em alcoolistas crônicos / A morphometric study of periarteriolar myocardial fibrosis in chronic alcoholics

O uso crônico abusivo do álcool causa uma ampla variedade de alterações sistêmicas, entre elas cardiopatia. A doença alcoólica cardíaca (DAC) apresenta-se com um quadro clínico bastante similar ao da miocardiopatia dilatada, mas admite-se que as manifestações clínicas e as lesões histológicas são mais discretas e, aparentemente, possuem certo potencial de regressão. Fibrose com distribuição e intensidade variáveis temsido uma alteração frequentemente observada. Neste trabalho foi realizado um estudo histoformométrico da fibrose periarteiolar miocárdica em dezenove indivíduos alcoolistas autopsiados na cidade do Recife. O grupo controle de doze indivíduos sem história de alcoolismo. Preparações histológicas com 4im de espessura obtidas da parede livre do ventrículo esquerdo foram coradas pelo tricrômico de Masson e examinadas com o Sistema Interativo de Análise de Imagens MOP VIDEOPLAN (Kontron Eletronic Group, Munique). A área (ìm²) periarteriolar ocupada por colágeno foi significativamente maior no grupo alcoolista do que nos controles (4.67,2 ñ 2.753,2 vs 2.300,8 ñ 1.265,4; P<0,05). Os resultados indicam que, de fato, ocorre alterações fibróticas em torno de arteróolas na DAC. As modificações do arcabouço colágeno cardíaco têm repercussões funcionais relevantes e podem resultar dos efeitos tóxicos diretos do álcool e de seus subprodutos sobre as miocélulas, ou de lesões na microcirculação miocárdica

Doença do coraçäo em alcoolistas crônicos: estudo de 19 casos / The heart in chronic alcoholics: a pathology study of 19 cases

O uso crônico e abusivo do alcool causa uma ampla variedade de alterações sistemicas, entre elas cardiopatia. A doença alcoolica cardíaca(DAC) apresenta-se como um quadro clínico bastante similiar ao da miocardiopatia dilatada, mas admite-se que as alterações clínicas e histológicas säo mais discretas e aparentemente, possuem certo potencial de regressäo. Neste trabalho foi estudado o caraçäo de 19 alcoolistas autopsiadas na cidade do recife. o grupo controle constatou de doze indivíduos sem historia de alcoolismo. O peso cardíaco do grupo alcoolista foi maior que no grupo controle (299,ñ14,5g vs256,2ñ18,2g), entretanto sem alcançar significância estatística. A espessura da parede e altura das câmeras ventriculares também foram maiores do que no grupo controle, mas apenas a altura do ventrículo direito mostrou uma diferença estatisticamente significante. As alterações histológicas foram represeentadas por fibrose predominantemente perivascular, vacuolizaçäo e acúmulo de lipofuscina em miocardiócitos, além de infiltrado inflamatório mononuclear leve. O dano miocárdico é inespecífico e atribuível aos efeitos tóxicos diretos do álcool onde seus subprodutos, como acetaldeído e acetato

Estudo Morfométrico da rede arteriolar miocárdica em indivíduos alcoolistas crônicos / Morphometric study of myocardic arteriolar net in chronic alcaholic patients

A patogênese da doença alcoolica cardíaca não é completamente conhecida. Segundo uma das hipóteses, as lesões miocárdicas resultariam de alterações na parede dos vasos. Para avaliar possíveis alterações vaculares parietais, foi realizado estudo morfométrico de arteíolas miocárdica em doze alcoolistas crônicos (nove homens e três mulheres, com idade variando de 24 a 45 anos) e em oito controles (três homens e cinco mulheres, com idade variando entre 20 e 39 anos). Cortes histólogicos de seções transversais, longitudinais e oblíquas da parede livre do ventrículo esuerdo foram analisados em sistema semi-automático de análise de imagem. Não se obseervaram diferenças estatisticamente significativas na espessura da parede articular entre os dois grupos. É possível, portanto, que alteraçõess vasculares, pelo nenos no que se refere a rede arteriolar miocárdica, não contribuam significativamente para a doença alcoólica cardíaca

The Echocardiographic Finding of Alcoholic Cardiomyopathy after Cessation of Alcohol

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.

O significado da abstinência do álcool na cardiomiopatia alcoólica com disfunçäo ventricular moderada / The significance of alcohol abstinence in alcoholic cardiomyopathy with moderate left ventricular dysfunction

Objetivo - Avaliar o papel da abstenção alcoólica, no período de 12 meses, na cardiomiopatia alcoólica (CMA) com disfunção ventricular de grau moderado, em pacientes tratados com esquema anticongestivo. Métodos - Estudo observacional prospectivo com 20 pacientes com CMA, 9 (45%) na classe funcional (CF) II e 11 (55%) na CF III, 16 (80%) homens, predomínio de negros (55%), de 35 a 56 (x=45) anos, com consumo pesado de álcool (>80g etanol/dia), por período de 51 a 112 (x=85) meses, que concordaram, inicialmente, em particular de programa de apoio, com psicoterapia de grupo, além do acompanhamento clínico com realização de exames não invasivos, antes do início do programa e após 12 meses da terapia, e foram divididos em dois grupos, o 1 (G-I) constituído pelos que atingiram a abstinência e o 2 (G-II) pelos não abstêmios. Resultados - Após 12 meses, 11 (55%) pacientes permaneciam em terapia de apoio, 8 (72,72%) no G-I, enquanto os 9 (45%) que não se mantiveram no programa, apenas 2 (22,22%) tinham logrado abstinência (G-I). Ao fim da avaliação, alcançamos número igual de pacientes entre os grupos. Comparando os grupos observamos: a) menores valores médios dos diâmetros sistólicos (DSVE) e diastólico (DDVE) do ventrículo esquerdo no G-I; b) maior número de internações no G-II (3) em relação ao G-I (1); c) na evolução clínica, maior número de pacientes do G-I, entre os que apresentaram melhoras (3 G-I e 1 G-II) e que permaneceram inalterados (6 G-I e 3 G-II), além do maior número de pioras entre o G-II (1 G-I e 5 G-II). Conclusão - Apesar do desejo inicial favorável, a abstinência só foi obtida em 50% dos pacientes com CMA e disfunção ventricular moderada, porém, quando alcançada, apresentou melhor evolução (melhoras + inalterados = 90%), com maior redução do DSVE e do DDVE (p<0,001), devendo sempre ser perseguida mesmo na presença de moderada disfunção ventricular.

Doppler Echocardiographic Evaluation of Left and Right Ventricular Filling in Young Chronic Alcoholics / 대한내과학회지

OBJECTIVES: It is well known that many chronic alcoholics manifest diastolic dysfunction of left ven tricle in its early stage. But the effects of chronic alcohol drinking on right ventricular function are not well understood. Thus left ventricular filling impair ment and its effects to right ventricular diastolic function were evaluated in young chronic alcoholics. METHODS: For the evaluation of left and right ventricular diastolic function in chronic alcoholics, 30 young chronic alcoholics and 28 control subjects were studied by pulsed Doppler echocardiography at the left and right ventricular inflow. Peak E velocity, peak A velocity, E/A velocity ratio, acceleration time and deceleration time were measured as diastolic filling parameters. RESULTS: 1) In the chronic alcoholics, the interventricular septum and posterior wall were thicker and left ventricular muscle mass was significantly increased than that in controls. 2) Among 30 cases of chronic alcoholics, 8 cases(26.7%) showed that the E/A ratio of the left ventricle was less than 1.0 and the deceleration time of the left ventricle was more than 240msec, where as 12 cases(40.0%) showed that the E/A ratio of the left ventricle was less than 1.0. 3) Among 30 cases of chronic alcoholics, 8 cases (26.7%) showed that the E/A ratio of the right ventri cle was less than 1.0 and the deceleration time of the right ventricle was more than 232msec, whereas 14 cases(46.7%) showed that the E/A ratio of the right ventricle was less than 1.0. 4) The RV E/A ratio was significantly correlated with the LV E/A ratio(r=0.697, p<0.001). 5) Blood pressure, ejection fraction, left ventricular mass, E/A ratio and deceleration time of both ventricles were not significantly different in comparison with the daily average amount, duration of ingestion, and total lifetime dose of alcohol. CONCLUSION: In all chronic alcoholics less than 50 years of age, the left ventricular systolic function was normal. But Doppler echocardiography showed that diastolic dysfunction of the left and right ventricles was present in 8 cases of 30 chronic alcoholics. Right ventricular diastolic dysfunction was closely related with left ventricular diastolic dysfunction. In conclu sion, diastolic dysfunction of both ventricle in chronic alcoholics may be the earliest functional sign of preclinical alcoholic cardiomyopathy.