Echocardiographic markers of early alcoholic cardiomyopathy: Six-month longitudinal study in heavy drinking patients.

• Echocardiographic features of early-alcoholic cardiomyopathy (ACM) are not well-defined. • Patients with AUD who drink heavily may present with early signs of ACM (abnormal E/e' ratio), despite the absence of clinical and/or EKG findings. • After six months, E/e' ratio was significantly reduced among those patients who reduced their alcohol consumption below heavy drinking levels. • These findings may reflect an early feature of ACM that precedes structural changes. The development of alcoholic cardiomyopathy (ACM) is related to chronic excessive alcohol use. However, features of early-stage ACM are still unclear. We assessed echocardiographic characteristics of patients with alcohol dependence (DSM-IV criteria) during a six-month treatment period. Active drinking patients, heavy alcohol users, without heart disease, referred to our Alcohol Addiction Unit were enrolled in the study. After signing informed consent, patients started outpatient treatment program. Echocardiography was performed at enrollment, then three and six months afterwards, by cardiologists blinded to drinking status. Forty-three patients (36 males, 7 females) were enrolled. At six months, 20 patients (46.5%) reduced alcohol consumption below heavy drinking levels. Although within normal range, baseline mean IVS thickness and mean LVDD were significantly higher (p < 0.001) and mean EF significantly reduced (p = 0.009), as compared to age-matched mean references. Mean E/A ratio, DcT and LA diameter were significantly different (p < 0.001) from mean references, but within normal range. Baseline mean E/e' ratio was significantly higher than the mean reference (p < 0.001) and out of the normal range. A significant correlation between the number of drinks per drinking days in the 7 days before baseline assessment and E/e' ratio was observed (p = 0.028). After six months, a trend-level reduction of mean E/e' ratio (p = 0.051) was found in the whole sample; this reduction was statistically significant (p = 0.041) among patients reducing drinking, compared to baseline. Altered E/e' ratio may characterize early-ACM before the occurrence of relevant echocardiographic alterations. The reduction of alcohol consumption could restore this alteration after six months. The clinical history of alcoholic cardiomyopathy. Persistent heavy alcohol use (more than 4 drinks on any day or more than 14 drinks per week for men, and more than 3 drinks on any day, or more than 7 drinks per week for women) coupled with individual susceptibility (ethnicity, gender, age, and genetic characteristics) leads to alcoholic cardiomyopathy (ACM). Echocardiographic characteristics of early-ACM are not completely known. We evaluated a sample of 43 patients with alcohol use disorder (AUD) and a longstanding history of heavy alcohol use, without heart disease, during a six-months AUD treatment program. We found an abnormal mean baseline E/e' ratio, significantly higher than mean age-matched reference. After six months, E/e' ratio was significantly reduced among patients who reduced their drinking below heavy alcohol levels. These findings may reflect an early feature of ACM, appearing earlier than structural alterations. Increased LV filling pressure could contribute to four-chamber dilatation of end-stage ACM. Persistent heavy alcohol consumption is the key mechanism for the progression to end-stage ACM, characterized by dilated cardiomyopathy with symptomatic heart failure with reduced ejection fraction (HFrEF). [Display omitted] [ABSTRACT FROM AUTHOR]