Differences of disease progression in congestive heart failure due to alcoholic as compared to idiopathic dilated cardiomyopathy

Abstract

In patients with alcoholic cardiomyopathy there is evidence that mild heart failure is reversible if patients abstain from alcohol, but there is no consensus whether the disease is progressive once structural myocardial dilatation has evolved. The aim of the present study was to compare the long-term course of congestive heart failure due to alcoholic and idiopathic dilated cardiomyopathy. Of 75 patients with overt congestive heart failure, 23 had alcoholic cardiomyopathy and were compared to 52 patients with idiopathic cardiomyopathy. The mean age was 48 ± 12 years. Despite medical therapy, heart failure class New York Heart Association III-IV was present in 52% of patients with alcoholic and 47% of patients with idiopathic cardiomyopathy (not significant). Their mean left ventricular ejection fraction was 30 ± 12% vs 28 ± 12% and left ventricular end-diastolic volumes were 264 ± 125 ml and 254 ± 100 ml respectively (not significant). Overall survival at 1, 5 and 10 years was 100%, 81% and 81% for the group with alcoholic dilated cardiomyopathy and 89%, 48% and 30% for the group with idiopathic cardiomyopathy, respectively (P=0041), and the difference was even greater for transplant-free survival P=0-005). Clinical and invasive signs of left and right heart failure as well as left ventricular dimensions were predictive of a fatal outcome; however, symptom duration and left ventricular volumes were only predictive in patients with idiopathic cardiomyopathy, suggesting that in the two patient groups different mechanisms may lead to death. Mortality in patients with severe congestive heart failure and left ventricular dilatation due to alcoholic cardiomyopathy is significantly lower than that in patients with idiopathic cardiomyopathy and similar degrees of heart failure. Thus, despite structural changes inherent in marked left ventricular dilatation, disease progression in alcoholic dilated cardiomyopathy is different from that in idiopathic cardiomyopathy and thus may have implications for the choice of therapy.

Collagen content, but not the ratios of collagen type III/I mRNAs, differs among hypertensive, alcoholic, and idiopathic dilated cardiomyopathy

“…Data from the literature show that, compared with patients with idiopathic dilated cardiomyopathy, patients with alcoholic and hypertensive cardiomyopathy have a better survival rate (5). One may speculate that the loss of collagen fibers from the matrix could lead to progressive dilation and impairment of cardiac pump performance, because the myocytes are not properly linked.…”

“…Despite recent major therapeutic advances, chronic heart failure still has a poor prognosis. Knowledge on the underlying cause of the cardiomyopathy has prognostic value (2)(3)(4)(5)(6). Mortality in patients with similar degrees of congestive heart failure and left ventricular dilatation due to alcoholic cardiomyopathy is significantly lower than that for patients with idiopathic cardiomyopathy (5).…”

O papel do acúmulo de colágeno no interstício miocárdico na sobrevida dos pacientes com cardiomiopatia dilatada idiopática e chagásica

“…Idiopathic dilated cardiomyopathy (IDCM) has an indeterminate origin, once secondary causes are ruled out. In the United States, its incidence is estimated at 5 to 8/100,000 inhabitants in the population in general, which represents one fourth of dilated cardiomyopathies, with a prevalence adjusted for age of 36/100,000 of the population in general, a 5-year overlife rate of 25% to 65%, depending on the stage of the disease, and annual mortality of 10,000 cases [1][2][3][4] . Chagasic dilated cardiomyopathy (CDCM) is considered an inflammatory disease secondary to infection by a parasite, Trypanosoma cruzi.…”

Reversible Dilated Cardiomyopathy: Into the Thaumaturgy of the Heart - Part 2

“…In most studies on the natural history and the long-term prognosis of ACM, an amount of 80 g a day (equivalent to 10 U or 5 glasses of 12% wine or 3-4 pints of beer) during at least 5 years was deemed sufficient to produce the disease. [32][33][34][35] However, average alcohol consumption shown by the patients included in these series was much higher and consumption periods were much longer. Furthermore, the accepted definition of ACM does not take into account important factors such as body mass index (BMI) or sex.…”