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Cardiac function in alcohol-associated systemic hypertension
Insights
Hypertension in alcoholics, even temporary, is linked to abnormal heart function and increased cardiac stress. This suggests a potential precursor to alcohol-induced heart failure.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Alcohol cardiomyopathy pathogenesis remains unclear.
- Systemic hypertension affects approximately one-third of individuals with alcohol use disorder.
- Understanding the relationship between hypertension and left ventricular (LV) function in alcoholics is crucial.
Purpose of the Study:
- To analyze the impact of systemic hypertension on left ventricular (LV) function in alcoholics.
- To compare cardiac function in hypertensive versus normotensive alcoholics after withdrawal.
- To investigate the role of elevated LV stress and mass in hypertensive alcoholics.
Main Methods:
- Evaluated 66 alcoholics 4-5 days post-withdrawal, categorizing them by blood pressure.
- Utilized echocardiography to assess preejection period/LV ejection time (PEP/ET) ratio and LV function.
- Measured LV mass and calculated LV stress and stress-to-mass ratio.
Main Results:
- Hypertensive alcoholics exhibited a significantly more abnormal PEP/ET ratio compared to normotensive alcoholics.
- Elevated LV stress was observed in both hypertensive and normotensive alcoholics, but the stress-to-mass ratio was markedly higher in hypertensive individuals.
- Hypertensive alcoholics displayed signs of LV "hyperfunction," indicated by an increased stress/LV end-systolic volume ratio.
Conclusions:
- Hypertension, even transient, is associated with more impaired cardiac function in alcoholics.
- Elevated LV stress and mass ratio in hypertensive alcoholics suggests increased mechanical load.
- Hyperdynamic LV features in hypertensive alcoholics may indicate an early stage of heart failure.
Abstract:
The pathogenesis of alcohol cardiomyopathy is obscure. Because systemic hypertension is observed in one-third of alcoholics, the relation of this finding to left ventricular (LV) function was analyzed in 66 alcoholics (26 with a blood pressure of 160/95 mm Hg or higher) 4 to 5 days after alcohol withdrawal. Hypertensive alcoholics had a more abnormal ratio of preejection period/LV ejection time (PEP/ET) (0.398 +/- 0.01 vs 0.35 +/- 0.01, p less than 0.02) than normotensive alcoholics (matched normal 0.290 +/- 0.01). Hypertensive alcoholics (transitory hypertension) with blood pressures of 120/80 mm Hg or less at time of study also had more abnormal PEP/LVET than matched normotensive alcoholics (0.415 +/- 0.03 vs 0.331 +/- 0.01, p less than 0.05). In both hypertensive (77 +/- 6 dynes/cm2 X 10(3)) and normotensive alcoholics (67 +/- 4 dynes/cm2 X 10(3) LV stress was elevated (normal 46 +/- 3 dynes/cm2 X 10(3), both p less than 0.02). However, LV mass was not increased (hypertensive 96 +/- 4 g/m2; vs normotensive 100 +/- 4 g/m2; (normal 92 +/- 5 g/m2), resulting in a markedly increased stress to mass ratio (hypertensive 0.8 +/- 0.06; Normal 0.05 +/- 0.05, p less than 0.02). Hypertensive alcoholics also had LV "hyperfunction," with an increased stress/LV end-systolic volume ratio (1.7 +/- 0.1 vs 1.3 +/- 0.1 dynes/cm2 X 10(3)/ml, p less than 0.02). Thus, hypertensive alcoholics, even those with transitory hypertension, have more abnormal cardiac function than normotensive alcoholics. Presence of hypertension with hyperdynamic LV features may be a prelude to heart failure.