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Echocardiographic abnormalities in chronic asymptomatic alcoholics
L L Cregler1, T M Worner, H Mark
1Department of Medicine, Bronx VA Medical Center, New York.
Insights
Alcohol abuse and hypertension may impair heart function more severely together than separately. Studies show combined conditions negatively impact left ventricular function and compensatory responses.
Area of Science:
- Cardiology
- Internal Medicine
- Toxicology
Background:
- Alcohol abuse is a known cause of high blood pressure.
- The impact of hypertension on alcohol-induced left ventricular dysfunction is unclear.
Purpose of the Study:
- To investigate the effects of combined alcohol abuse and hypertension on left ventricular function.
- To compare cardiac function in hypertensive alcoholics versus non-hypertensive alcoholics and non-alcoholics.
Main Methods:
- Echocardiography and systolic time intervals were used to assess cardiac function in 50 asymptomatic male alcoholics and control groups.
- Patients were categorized into groups based on alcohol consumption and hypertension status.
Main Results:
- Hypertensive alcoholics showed reduced ejection fraction and shortening fraction.
- Left ventricular mass indices were increased in hypertensive alcoholics compared to controls, but less than in hypertensive non-alcoholics.
- Alcoholics exhibited an inappropriate compensatory response to afterload, indicated by altered wall stress to mass ratios.
Conclusions:
- Combined alcohol abuse and hypertension appear more detrimental to left ventricular function than either condition alone.
- The study suggests an impaired compensatory mechanism in response to increased afterload in hypertensive alcoholics.
Abstract:
Alcohol abuse is a frequent contributor to elevated blood pressure, but the literature is ambiguous about the role of hypertension in producing left ventricular dysfunction. Fifty asymptomatic male alcoholics admitted for detoxification were studied using echocardiograms and systolic time intervals. Alcoholics were separated into Group I (28 with hypertension) and Group II (22 without hypertension). Forty-four patients had analyzable echocardiograms and were compared to 29 nonalcoholics. Group III consisted of 14 nonalcoholics with hypertension. Group IV consisted of 15 normotensive nonalcoholics (controls). The ejection fraction and shortening fraction were reduced in Group I (p less than 0.05). Hypertensive alcoholics had increased left ventricular mass indices but less than hypertensive nonalcoholics. Left ventricular wall stress was compared to mass as an index of ventricular compensation. The wall stress to mass index for hypertensive alcoholics was 1.65 as compared to 1.43 for the controls. Alcoholics without hypertension had a wall stress to mass ratio of 1.54. Hypertensive patients had a reduced wall stress to mass ratio of 1.38 when compared to controls. These data suggest an inappropriate compensatory response to afterload. Alcohol and hypertension combined may be more harmful to left ventricular function than either disease alone.