[Echocardiographic evaluation of cardiac involvement in patients with chronic alcoholism]

Since chronic alcoholics may accompany with asymmetric septal hypertrophy (ASH), the purpose of this study was to find the difference in cardiac function of such cases from the patients with hypertrophic cardiomyopathy. Ninety-seven alcoholic patients (59 non-cirrhotics and 38 cirrhotics) were examined by non-invasive methods including two-dimensional echocardiography and dye dilution method, and these data were compared with those of 16 normal subjects and 26 patients with hypertrophic cardiomyopathy. The results were as follows: Interventricular septal thickness of more than 12 mm was observed in 25.4% of the non-cirrhotics and 28.9% of the cirrhotics. Furthermore, ASH was present in 23.7% of the former and 18.4% of the latter, when ASH was defined as the septal to posterior wall ratio greater than 1.3 with the interventricular septal thickness greater than or equal to 12 mm. In 66.7% of the chronic alcoholics with ASH, hypertrophy was predominantly located in the septum, however 53.8% of the patients with hypertrophic cardiomyopathy had ASH in association with the thickened left ventricular posterior wall. In 21 chronic alcoholics with ASH, ejection indices such as ejection fraction and mean VCF were moderately increased, although scattered widely, as compared with those of the normal subjects. Latent reduced ventricular function compensated by sympathetic overactivity was postulated based on left ventricular performance maintained normally as indicated by a decrease of end-systolic wall stress. Several possible factors including hypertension, catecholamine and metabolic abnormalities were analyzed to explain the genesis of ASH in chronic alcoholics, but the true etiology remained unknown. In conclusion, ASH associated with chronic alcoholism is a type characteristic of alcoholic cardiomyopathy, and seems to belong to a clinical entity different from hypertrophic cardiomyopathy from a standpoint of clinical symptoms, age and the pattern of left ventricular hypertrophy.