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[Course and prognosis of apparently primary congestive cardiomyopathies in chronic alcoholic patients]
Insights
Chronic alcoholic cardiomyopathy has a 50% 5-year mortality, with survival depending on left ventricular function. Early alcohol cessation improves prognosis, but advanced disease limits its benefit.
Area of Science:
- Cardiology
- Toxicology
- Internal Medicine
Context:
- Alcoholic cardiomyopathy affects chronic alcoholic patients.
- Prognostic factors for this condition require further definition.
Purpose:
- To analyze the clinical course and define prognostic factors in chronic alcoholic patients with primary congestive cardiomyopathy.
Summary:
- This study analyzed 36 male alcoholic patients (mean age 47) with congestive cardiomyopathy, finding 55% functional deterioration and 50% 5-year mortality.
- Sudden death (38%) was linked to ventricular arrhythmias, while other deaths resulted from end-stage heart failure.
- Survival rates were comparable to non-alcoholic cardiomyopathy and primarily depended on left ventricular function and ejection fraction.
- Early alcohol withdrawal was beneficial, but ineffective with severe left ventricular dysfunction.
- Ultrasound and radioisotope studies revealed segmental kinetic disorders and left ventricular thrombi, both indicating poor prognosis.
- Initial left atrial systolic diameter correlated with disease activity and prognosis.
Impact:
- Identifies key prognostic indicators for alcoholic cardiomyopathy, including left ventricular function, ejection fraction, and early alcohol cessation.
- Highlights the negative prognostic significance of segmental kinetic disorders and intracavitary thrombi.
- Suggests left atrial systolic diameter as a potential marker for disease activity.
Abstract:
The authors analyse a series of 36 chronic alcoholic patients with primary congestive cardiomyopathy. The clinical course of these cases was analysed in order to define the prognostic factors. All of the patients were male with a mean age of 47 years. 55 per cent of cases presented a functional deterioration. The 5 year mortality was 50 per cent. The high incidence of sudden death (38 per cent of deaths) was probably related to ventricular arrhythmias. The other deaths were due to end-stage heart failure. The survival did not differ significantly from that of primary congestive cardiomyopathy in non-alcoholic patients. It depends, above all, on the left ventricular function and is influenced by the initial value for the ejection fraction. Alcoholic withdrawal was found to be a beneficial prognostic factor when it was early, but it became ineffective in cases with major alteration in the left ventricular function. Ultrasound and radioisotope studies demonstrated the development of segmental kinetic disorders and intracavitary thrombi in the left ventricle. These lesions have a pejorative prognostic significance. The initial systolic diameter of the left auricle seems to have a prognostic value as it reflects the degree of activity of the disease.