Detection of Alcoholic Cardiomyopathy by Serum Enzyme and Isoenzyme Determination

Abstract

SUMMARY Serum creatine kinase and lactate dehydrogenase isoenzymes were studied in 73 patients with alcoholism, including two patients with clinical alcoholic cardiomyopathy and 28 patients with haemodynamic evidence (systolic time interval abnormality) of disordered myocardial function. No isoenzyme abnormalities suggestive of myocardial injury were observed. We conclude that isoenzyme examination is unsuitable for the early detection of myocardial damage from alcohol.Two patients showed clinical alcoholic cardiomyopathy. A further 28 patients showed increased PEPjLVET ratios without blood ethanol elevation. These patients were diagnosed as having subclinical cardiomyopathy.Serum total CK activity was increased in eight of these 30 subjects and HBD was elevated in three. Total CK was also raised in six and HBD in five of the remaining 43 patients without evidence of cardiac abnormality.Serum CK isoenzyme examination in all subjects showed only the 'muscle' (MM) isoenzyme. LD isoenzyme determination showed either a normal or isomorphic pattern (LD2, LDa increase) or a 'liver'j'muscle' pattern (increased LDs). NQ patient showed increase of the 'cardiac-specific' Ck-MB or LDI isoenzymes. et al., 1977). The upper reference limit (mean plus 2SD) for the PEPjLVET ratio determined in 49 healthy controls matched for age and sex was 0·350. ResultsSince STI values are known to alter during alcohol intoxication, blood ethanol levels were also measured for all subjects by gas-liquid chromatography (courtesy Dr J. Spencer-Peer). Patients and methodsSeventy-three documented alcoholic patients, 60 men (mean age 29 years) and 13 women (mean age 35 years), all previously consuming in excess of 80g ethanol per day, were studied immediately after admission to the Alcohol Unit at St Bernard's Hospital, Southall. A full clinical examination was carried out, blood samples were taken, and STI values measured.The following serum enzyme activities and isoenzymepatterns were determined, using methodology and normal values described previously (Krafft et al., 1977); creatine kinase (CK), hydroxybutyrate Discussion dehydrogenase (HBD); CK and lactate dehydrogenase(LD) isoenzymes.Determination of total CK and LD or HBD activity For STI measurement the electrocardiogram, in serum followed by CK and LD isoenzyme phonocardiogram, and carotid pulse pressure waves examination is widely used for the identification of were simultaneously recorded, and the pre-ejection myocardial injury. Total enzyme determination period relative to the left ventricular ejection time lacks cardiospecificity, and this is especially dis-(PEPjLVET ratio) was calculated. This value reflects advantageous when evidence of heart damage is the contractile efficiency of heart muscle (Lewis sought in alcoholics, in whom accompanying liver 165Measurement of enzymes and isoenzymes of cardiac origin in serum is of established value for the identification of myocardial damage. Alcohol is cardiotoxic. Clinical cardiomyopathy occurs in some 1-2% of chronic alcoholics, but haemody...

Myocardial metabolites of ethanol.

“…These results demonstrate the presence in human myocardium of a novel metabolite of ethanol that potentially may serve as a marker for exposure to alcohol and that could be relevant to the pathophysiology of excessive alcohol consumption leading to cardiac abnormalities. (Circ Res 52: 479-482, 1983) ALCOHOL-INDUCED heart muscle disease afflicts more than 200,000 patients (Bridgen and Robinson, 1964;Fink et al, 1979) and accounts for 3% of all cardiac admissions to city hospitals in the United States (Kramer et al, 1968). Manifestations include accumulation of myocardial triglycerides (Lochner et al, 1969;Regan et al, 1966;Ferrans et al, 1965;Kikuchi and Kako, 1970), decreased /J-oxidation of fatty acids (Kramer et al, 1968;Lochner et al, 1969;Regan et al, 1966;Segal at al., 1979), high grade atrial and ventricular arrhythmias, and congestive heart failure (Schwartz et al, 1975;Weishaar et al, 1977;Bing, 1978;Demakis et al, 1974).…”