eMedicine Specialties > Cardiology > Myocardial Disease and Cardiomyopathies

Cardiomyopathy, Alcoholic: Follow-up

Author: Eric D Popjes, MD, Assistant Professor, Department of Medicine, Division of Cardiology, Penn State Milton S Hershey Medical Center
Coauthor(s): Frank E Silvestry, MD, Director, PENN Cardiac Care at Radnor; Assistant Professor, Department of Medicine, Division of Cardiovascular Disease, University of Pennsylvania Health System
Contributor Information and Disclosures

Updated: Mar 13, 2008

Follow-up

Prognosis

  • The natural history of patients with alcoholic cardiomyopathy (AC) depends greatly on each patient's ability to cease alcohol consumption completely. Multiple case reports and small retrospective and prospective studies have clearly documented marked improvement and, in some patients, normalization of cardiac function with abstinence. The following reports and studies provide impressive data on the utility of abstinence and the confirmation of alcohol consumption as a cause of dilated cardiomyopathy (DC).
    • Nakanishi et al identified 11 patients with AC and reported significant improvement in 8 patients who abstained from alcohol use and marked worsening in the 3 patients who continued to abuse alcohol, including death from heart failure in 2 patients.10
    • A 12-month observation study of 20 patients with AC reported abstinence in 10 patients and noted smaller cavity diameters, better clinical evaluation findings, and fewer hospitalizations in the patients who abstained.
    • Guillo and colleagues evaluated 14 patients with AC over a 3-year period with serial examinations, ECGs, stress tests, echocardiograms, and MUGA scans. Of the 3 patients who continued to drink, 1 was lost to follow-up and 2 died. One patient underwent heart transplantation within the 3 years of follow-up observation, and one patient died from tamponade after an endomyocardial biopsy. Nine of the original 14 patients completed the 36-month follow-up period, 6 patients had marked improvement in symptoms and increased ejection fractions. The other 3 patients had no change in ejection fraction, one patient cut back alcohol consumption, and another patient resumed use after a period of abstinence.11
    • A 1- and 4-year follow-up study of 55 men with alcoholism showed that abstinence and controlled drinking of up to 60 g/day (4 drinks) resulted in comparable improvement in left ventricular ejection fraction. Ten patients who continued to drink higher amounts of alcohol all died during the follow-up period.
  • In 1974, Demakis and colleagues completed what is perhaps the largest evaluation of the natural history of AC. They prospectively followed 57 patients with AC and divided them into 3 groups: 15 patients who improved clinically, 12 patients who remained stable, and 30 patients whose conditions deteriorated. Of the 39 patients who continued to drink, only 4 patients improved. Eleven of the 18 patients who abstained improved; however, the condition of 3 patients who abstained continued to deteriorate. Overall, the 2 factors that were associated with a better prognosis were abstinence and a shorter duration of symptoms before the initiation of therapy.12
  • Several studies have compared the natural history of AC with that of DC.
    • In 1996, Prazak et al conducted a retrospective study comparing 23 patients with AC to 52 patients with idiopathic DC. The 2 groups had similar ejection fractions, New York Heart Association class symptoms, and overall LV volume. The sole endpoint was all-cause mortality. The 1-, 5-, and 10-year survival rates for AC were 100%, 81%, and 81%, respectively, compared to 89%, 48%, and 30%, respectively for idiopathic DC. When transplant-free survival was compared, the difference was more impressive, with 10-year survival rates of 81% and 20%, respectively.13
    • This is in contrast to a 1993 study by Redfield et al that showed no difference in mortality between patients with AC and patients with idiopathic DC.14
    • Prazak et al speculate that the difference may be due to more complete abstinence and aggressive medical therapy in the patients in their study.13

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More on Cardiomyopathy, Alcoholic

Overview: Cardiomyopathy, Alcoholic
Differential Diagnoses & Workup: Cardiomyopathy, Alcoholic
Treatment & Medication: Cardiomyopathy, Alcoholic
Follow-up: Cardiomyopathy, Alcoholic
References
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References

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Further Reading

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Keywords

alcoholism, alcohol consumption, alcohol abuse, ethanol consumption, ethanol abuse, ethanol toxicity, alcohol toxicity, cardiovascular disease, CVD, cardiac enlargement, cardiac failure, heart failure, alcoholic cardiomyopathy, AC, arrhythmia, atrial fibrillation, atrial flutter, supraventricular arrhythmia, premature ventricular contractions, sudden death, hypertension, stroke, dilated cardiomyopathy, DC, acute ethanol-induced injury, beriberi heart disease, thiamine deficiency, acetaldehyde, myocarditis

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Contributor Information and Disclosures

Author

Eric D Popjes, MD, Assistant Professor, Department of Medicine, Division of Cardiology, Penn State Milton S Hershey Medical Center
Eric D Popjes, MD is a member of the following medical societies: American College of Cardiology, Heart Failure Society of America, and International Society for Heart and Lung Transplantation
Disclosure: Nothing to disclose.

Coauthor(s)

Frank E Silvestry, MD, Director, PENN Cardiac Care at Radnor; Assistant Professor, Department of Medicine, Division of Cardiovascular Disease, University of Pennsylvania Health System
Frank E Silvestry, MD is a member of the following medical societies: American College of Cardiology, American Medical Association, and American Society of Echocardiography
Disclosure: Nothing to disclose.

Medical Editor

Gary E Sander, MD, PhD, Professor, Department of Internal Medicine, Division of Cardiology, Tulane University Health Sciences Center
Gary E Sander, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American College of Cardiology, American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Heart Association, American Society of Hypertension, Heart Failure Society of America, Louisiana State Medical Society, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Frank M Sheridan, MD, Cardiology, Providence Everett Medical Center
Frank M Sheridan, MD is a member of the following medical societies: American College of Cardiology, American Heart Association, and Society for Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

CME Editor

Amer Suleman, MD, Consultant in Electrophysiology and Cardiovascular Medicine, Department of Internal Medicine, Division of Cardiology, Medical City Dallas Hospital
Amer Suleman, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Institute of Stress, American Society of Hypertension, Federation of American Societies for Experimental Biology, Royal Society of Medicine, and Society of Cardiac Angiography and Interventions
Disclosure: Nothing to disclose.

Chief Editor

Patrice Delafontaine, MD, FACC, FAHA, FACP, FESC, Sidney W and Marilyn S Lassen Professor of Cardiovascular Medicine, Chief, Section of Cardiology, Director, Cardiovascular Center of Excellence, Tulane University; Professor of Physiology, Chair, Department of Medicine, Tulane University School of Medicine
Patrice Delafontaine, MD, FACC, FAHA, FACP, FESC is a member of the following medical societies: Alpha Omega Alpha, American Association for the Advancement of Science, American College of Cardiology, American College of Physicians, American Diabetes Association, American Federation for Clinical Research, American Federation for Medical Research, American Heart Association, American Medical Association, American Society for Clinical Investigation, Association of American Physicians, Association of Professors of Cardiology, Association of Professors of Medicine, Endocrine Society, European Society of Cardiology, Louisiana State Medical Society, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

 
 
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