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CLINICAL STUDIES

Early changes in left ventricular function in chronic asymptomatic alcoholics: relation to the duration of heavy drinking

Aleksandar M. Lazarevi, MD^*, Satoshi Nakatani, MD, PhD, FACC^*, Aleksandar N. Nekovi, MD, Jelena Marinkovi, PhD, Yoshio Yasumura, MD, PhD^*, Djordjo Stojii, MD, PhD, Kunio Miyatake, MD, PhD, FACC^*, Milovan Boji, MD, PhD^* and Aleksandar D. Popovi, MD, PhD, FACC, FESC

^* Cardiology Division, National Cardiovascular Center, Suita, Osaka, Japan
Cardiovascular Research Center, Dedinje Cardiovascular Institute, Belgrade University Medical School, Belgrade, Yugoslavia
Cardiology Division, Banja Luka Medical Center, Banja Luka University Medical School, Banja Luka, Republika Srpska, Bosnia and Herzegovina

Manuscript received August 5, 1999; revised manuscript received November 16, 1999, accepted January 7, 2000.

Reprint requests and correspondence: Dr. Satoshi Nakatani, Cardiology Division, National Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, 565-8565 Osaka, Japan
nakatas{at}hsp.ncvc.go.jp

OBJECTIVES

This study sought to assess preclinical cardiac abnormalities in chronic alcoholic patients and possible differences among alcoholics related to the duration of heavy drinking.

BACKGROUND

Chronic excessive alcohol intake has been reported as a possible cause of dilated cardiomyopathy. However, before the appearance of severe cardiac dysfunction, subtle signs of cardiac abnormalities may be identified.

METHODS

We studied 30 healthy subjects (age 44 ± 8 years) and 89 asymptomatic alcoholics (age 45 ± 8 years, p = NS) divided into three groups, with short (S, 5–9 years, n = 31), intermediate (I, 10–15 years, n = 31) and long (L, 16–28 years, n = 27) duration of alcoholism. Transmitral early (E) and late (A) Doppler flow velocities, E/A ratio, deceleration time of E (DT) and isovolumic relaxation time (IVRT) were obtained. Left ventricular (LV) wall thickness and volumes were also determined by echocardiography, and LV mass and ejection fraction (EF) were calculated.

RESULTS

The alcoholics had prolonged IVRT (92 ± 11 vs. 83 ± 7 ms, p < 0.001), longer DT (180 ± 20 vs. 170 ± 10 ms, p < 0.01), smaller E/A (1.25 ± 0.34 vs. 1.40 ± 0.32, p < 0.05), larger LV volumes (73 ± 8 vs. 65 ± 7 ml/m², p < 0.001 for end-diastolic volume index; 25 ± 4 vs. 21 ± 2 ml/m², p < 0.001 for end-systolic volume index), higher LV mass index (92 ± 14 vs. 78 ± 8 g/m², p < 0.001) and thicker posterior wall (9 ± 1 vs. 8 ± 1 mm, p < 0.001). Ejection fraction did not differ between the two groups (66 ± 4 vs. 67 ± 2%). Deceleration time of the early transmitral flow velocity was longer in groups L (187 ± 18 ms) and I (185 ± 16 ms) compared with group S (168 ± 17 ms, p < 0.001 for L and I vs. S), whereas A was higher in group L compared with S (43 ± 10 vs. 51 ± 10 cm/s, p < 0.005). Multiple regression analysis identified duration of heavy drinking as the most important variable affecting DT and A.

CONCLUSIONS

Left ventricular dilation with preserved EF and impaired LV relaxation characterized LV function in chronic asymptomatic alcoholic patients. It appeared that the progression of abnormalities in LV diastolic filling related to the duration of alcoholism.

Abbreviations and Acronyms   A = peak late transmitral flow velocity   DT = deceleration time of the early transmitral flow velocity   E = peak early transmitral flow velocity   EF = ejection fraction   I = intermediate duration of alcoholism   IVRT = isovolumic relaxation time   IVST = diastolic interventricular septum thickness   L = long duration of alcoholism   LV = left ventricular   LVDD = left ventricular diastolic diameter   PWT = diastolic left ventricular posterior wall thickness   S = short duration of alcoholism

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