DOI: http://dx.doi.org/10.18203/2349-3933.ijam20211473

Estimation of left ventricular function in chronic alcoholics

K. S. Sindhya, Arthi P. S.

Abstract


Background: Alcohol abuse is one of the leading causes of millions of deaths, it is also a burden in society. Direct toxicity of ethanol affects cardiac muscle Acute intoxication shows pathological electrocardiogram changes such as sinus tachycardia in alcohol dependence syndrome, sinus arrhythmias, prolongation of QT interval, ventricular polarising complexes, poor progression of R wave, torse de pointes. Changes found in echocardiography are alteration in septal and ventricular wall thickness, left atrial dimensions, left ventricle dimension and mass.

Methods: Patients attending outpatient and inpatients section in our tertiary care hospital Shri Balaji Vidhyapeet University were considered in study for a period of two years. Study size was 85 patients, Data were collected regarding proportion of ethanol intake, history of duration, symptoms related to cardiovascular system, blood parameters including thyroid function test, blood sugars are done, body mass index calculated, blood pressure recorded master chart made for statistical verification. The three-dimensional echocardiography in M mode is done by our cardiologist.

Results: Echocardiography findings were correlated with duration of intake of alcohol end diastolic volume index (EDVI), End systolic volume index (ESVI), Left ventricle mass index (LVMI) had positive correlation of p-value less than 0.05. when quantity of ethanol intake correlated with echocardiography, Left ventricular inner dimension (LVID), fractional shortening (FS), ejection fraction (EF), posterior wall thickness, E/A ratio has no significance with p value. Abnormality is noted in left ventricle diastolic function and is corresponded to quantity and duration of alcohol. Moderate amount of less than 150grams of ethanol did not showed toxic effects in heart while severe quantity and duration more than ten years of intake showed left ventricle dysfunction

Conclusions: Ethanol consumption in massive amount impair cardiac contractile function. Change in left ventricle volume takes place before the defect in the ventricular filling, which would be a marker for effect of ethanol in heart.


Keywords


Alcohol abuse, LV dysfunction, Intoxication

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References


Regan TJ. Alcohol and the cardiovascular system. JAMA. 1990;264:377-81.

Spodick DH, Pigott VM, Chirife R. Preclinical cardiac malfunction in chronic alcoholism. N Engl J Med. 1972;287:677-81.

Arroyo LH, Regan TJ. Ethanol and the heart. In: Topol EJ, editor. Textbook of Cardiovascular Medicine. 1st ed. Philadelphia: Lippincott-Raven. 1998;219-29.

Askanas A, Udoshi M, Sadjadi SA. The heart in chronic alcoholism: a noninvasive study. Am Heart J. 1980;99:9-16.

Kino K, Imamitchi H, Morigutchi M, Kawamura K, Takatsu T. Cardiovascular status in asymptomatic alcoholics, with reference to the level of ethanol consumption. Br Heart J. 1981;46:545-51.

Friedman HS, Vasavada BC, Malec AM, Hassan KH, Shah A, Siddiqui S. Cardiac function in alcohol-associated systemic hypertension. Am J Cardiol. 1986;57:227-31.

Cerqueira MD, Harp GD, Ritchie JL, Stratton J, Walker D. Rarity of preclinical alcoholic cardiomyopathy in chronic alcoholics ,40 years of age. Am J Cardiol. 1991;67:183-7.

Urbano-Marquez A, Estruch R, Navarro-Lopez F, Grau JM, Mont L, Rubin E. The effects of alcoholism on skeletal and cardiac muscle. N Engl J Med. 1989;320:409-15.

Kupari M, Koskinen P, Suokas A, Ventila M. Left ventricular filling JACC. 2000: 1599-606.

Silpakit P, Kittirattanapaiboon P. The acohol use disorders identification test: Guidelines for use in primary care. 1st Ed. Bangkok: Tantawanpaper Company. 2009;1-41.

Harcombe AA, Ramsay L, Kenna JG. Circulating antibodies to cardiac proteinacetaldehyde adducts in alcoholic heart muscle disease. Clin Sci (Colch). 1995;88(3):263-8.

Mathews EC Jr, Gardin JM, Henry WL, Del Negro AA. Echocardiographic abnormalities in chronic alcoholics with and without overt congestive heart failure. Am J Cardiol. 1981;47(3):570-8.

Mahela. Electrocardiographic and Echocardiograohic Abnormalities in Chronic alcoholic patients. JAPI. 2003;51(132):1187.

Lazarevic. Cardiac Abnormalities in Chronic Alcoholic Patients. JACC. 2000;35(6):1599-606.

Ryan JM, Howes LG. Relations between alcohol consumption, heart rate, and heart rate variability in men. Heart. 2002;88(6):641-642.

Krasniqi A, Bostaca I, Dima-Cosma C, Crişu D, Aursulesei V. Arrhythmogenic effects of alcohol. Rev Med Chir Soc Med Nat Iasi. 2011; 115(4): 1052-6.

Pathophysiology-diagnosis-alcoholusedisorder-signs-symptoms-. Available at: https://img.grepmed. com/uploads/8234/pathophysiology-diagnosis-alcoholusedisorder-signs-symptoms-original.jpeg. Accessed on 23rd September, 2020.

Rehm J. The risks associated with alcohol use and alcoholism. Alcohol Res Health. 2011;34(2):135-43.

Hines LM, Rimm EB. Moderate alcohol consumption and coronary heart disease: a review. Postgrad Med J [Internet]. 2001;77(914):747-752.

Krenz M, Korthuis RJ. Moderate ethanol ingestion and cardiovascular protection: from epidemiologic associations to cellular mechanisms. J Mol Cell Cardiol. 2012;52(1):93-104.

Obad A, Peeran A, Little JI, Haddad GE, Tarzami ST. Alcohol-Mediated Organ Damages: Heart and Brain. Frontiers in Pharmacology. 2018;9:81.

Guo R, Hu N, Kandadi MR, Ren J. Facilitated ethanol metabolism promotes cardiomyocyte contractile dysfunction through autophagy in murine hearts. Autophagy. 2012;8(4):593-608.

Donohue TMJ. Autophagy and ethanol-induced liver injury. World J Gastroenterol. 2009;15(10):1178-85.

Lang CH, Frost RA, Summer AD, Vary TC. Molecular mechanisms responsible for alcohol-induced myopathy in skeletal muscle and heart. Int J Biochem Cell Biol. 2005;37(10):2180-95.

Fogle RL, Lynch CJ, Palopoli M, Deiter G, Stanley BA, Vary TC. Impact of chronic alcohol ingestion on cardiac muscle protein expression. Alcohol Clin Exp Res. 2010;34(7):1226-34.

Danziger RS, Sakai M, Capogrossi MC, Spurgeon HA, Hansford RG, Lakatta EG. Ethanol acutely and reversibly suppresses excitation-contraction coupling in cardiac myocytes. Circ Res. 1991;68(6):1660-8.

Aroor AR, Shukla SD. MAP kinase signaling in diverse effects of ethanol. Life Sci. 2004;74(19):2339-64.

Preedy VR, Ohlendieck K, Adachi J, Koll M, Sneddon A, Hunter R, et al. The importance of alcohol-induced muscle disease. J Muscle Res Cell Motil. 2003;24(1):55-63.

Adams MA, Hirst M. Metoprolol suppresses the development of ethanol-induced cardiac hypertrophy in the rat. Can J Physiol Pharmacol. 1990;68(5):562-7.

Patel VB, Corbett JM, Dunn MJ, Winrow VR, Portmann B, Richardson PJ, et al. Protein profiling in cardiac tissue in response to the chronic effects of alcohol. Electrophoresis. 1997;18(15):2788-94.

Zhang X, Klein AL, Alberle II NS, Norby FL, Ren BH, Duan J, et al. Cardiac-specific overexpression of rescues ventricular myocytes from ethanol-induced cardiac contractile defect. J Mol Cell Cardiol. 2003;35(6):645-52.

Steinbigler P, Haberl R, König B, Steinbeck G. P-wave signal averaging identifies patients prone to alcohol-induced paroxysmal atrial fibrillation. Am J Cardiol. 2003;91(4):491-4.

Machackova J, Barta J, Dhalla NS. Myofibrillar remodelling in cardiac hypertrophy, heart failure and cardiomyopathies. Can J Cardiol. 2006;22(11):953-68.

K. HG, Peter L, Uwe S, Zhong-Qun Y. Innate and Adaptive Immunity in the Pathogenesis of Atherosclerosis. Circ Res. 2002;91(4):281-91.

Lopes da Silva A, Ruginsk SG, Uchoa ET, Crestani CC, Scopinho AA, Correa FMA, et al. Time-Course of Neuroendocrine Changes and Its Correlation with Hypertension Induced by Ethanol Consumption. Alcohol Alcohol. 2013;48(4):495-504.

Piano MR, Rosenblum C, Solaro RJ, Schwertz D. Calcium sensitivity and the effect of the calcium sensitizing drug pimobendan in the alcoholic isolated rat atrium. J Cardiovasc Pharmacol. 1999;33(2):237-42.

Trevisani F, Sica G, Mainquà P, Santese G, De Notariis S, Caraceni P, et al. Autonomic dysfunction and hyperdynamic circulation in cirrhosis with ascites. Hepatology. 1999;30(6):1387-92.

Li Z, Guo X, Bai Y, Sun G, Guan Y, Sun Y, et al. The Association Between Alcohol Consumption and Left Ventricular Ejection Fraction: An Observational Study on a General Population. Medicine (Baltimore). 2016;95(21):e3763.

Scafa F, Mingrone R, Perotti M, Taccola A. Echocardiographic assessment of alcohol consumers in different clinical stages. Minerva Med. 1996;87(9):407-11.

Campbell RWF, Day CP, James OFW, Butler TJ. QT prolongation and sudden cardiac death in patients with alcoholic liver disease. Lancet. 1993;341(8858):1423-8.

Gonçalves A, Jhund PS, Claggett B, Shah AM, Konety S, Butler K, et al. Relationship between alcohol consumption and cardiac structure and function in the elderly: the Atherosclerosis Risk In Communities Study. Circ Cardiovasc Imaging. 2015;8(6):10.

Lazarević AM, Nakatani S, Nesković AN, Marinković J, Yasumura Y, Stojicić D, et al. Early changes in left ventricular function in chronic asymptomatic alcoholics: relation to the duration of heavy drinking. J Am Coll Cardiol. 2000;35(6):1599-606.

Askanas A, Udoshi M, Sadjadi SA. The heart in chronic alcoholism: a noninvasive study. Am Heart J. 1980;99(1):9-16.

Meng S, Guo L, Li G. Early changes in right ventricular longitudinal function in chronic asymptomatic alcoholics revealed by two-dimensional speckle tracking echocardiography. Cardiovasc Ultrasound. 2016;14(1):16.

Wang Y, Shan G, Shen J, Zhou Q, Tan B, Liu Y, et al. Assessment of left ventricular function in chronic alcoholics by real-time three-dimensional echocardiography. Medicine (Baltimore). 2017;96(5):e6033-e6033.

Cameron D, Bach D, Kolias T, LaBounty T. Modest Alcohol Consumption Is Associated With Favorable Findings On Echocardiography. J Am Coll Cardiol. 2019;73(9 Supplement 1):1605.