A modern view on the pathogenesis, diagnosis and treatment of alcoholic cardiomyopathy
https://doi.org/10.15829/1560-4071-2019-11-164-172
Abstract
Dilatation of the left ventricle cavity and its contractility decrease with the subsequent heart failure development against the background of prolonged excessive alcohol consumption is commonly called alcoholic cardiomyopathy (ACM). The direct toxic effect of ethanol and its metabolites on the myocardium, neuroendocrine disorders,other manifestations of alcoholism and a genetic predisposition play a significantrole in the development of this pathology. The purpose of this review is to study modern ideas about the mechanisms of development and course of ACM. In particular, special attention is paid to discussing the doses of alcohol necessary for the onset of symptoms and its regression. Actual data are presented in relation to a survey aimed at confirming alcohol abuse and the exclusion of alternative causes of myocardial injury, as well as treating patients and determining the prognosis.
About the Authors
Zh. D. Kobalava
The Peoples’ Friendship University of Russia
Russian Federation
Competing Interests: No relevant conflicts of interest
Russian Federation
Zhanna D. Kobalava - MD, DMedSc, Professor, Head of department of internal diseases.
Moscow.
Competing Interests: No relevant conflicts of interest
P. V. Lazarev
The Peoples’ Friendship University of Russia
Russian Federation
Competing Interests:
Russian Federation
Pavel V. Lazarev - MD, PhD, Assistant Professor.
Moscow.
Competing Interests:
No relevant conflicts of interest
A. S. Goncharov
City Clinical Hospital
Russian Federation
Competing Interests:
Russian Federation
Aleksandr S. Goncharov - MD, PhD, Head of department of ultrasound diagnostics.
Moscow.
Competing Interests:
No relevant conflicts of interest
References
1. Guzzo-Merello G, Cobo-Marcos M, Gallego-Delgado M, Garcia-Pavia P. Alcoholic cardiomyopathy. World J Cardiol. 2014;6(8):771-81. doi:10.4330/wjc.v6.i8.771.
2. Maisch B. Alcoholic cardiomyopathy: The result of dosage and individual predisposition. Herz. 2016;41(6):484-93. doi:10.1007/s00059-016-4469-6.
3. Yusupova AO. Alcoholic cardiomyopathy: basic aspects of epidemiology, pathogenesis and pharmacotherapy. Ration Pharmacother Cardiol. 2014;10(1):651-8. (In Russ.)
4. Russian statistical yearbook 2018. Statistical digest M.: Rosstat, 2018. p. 697. (In Russ.)
5. Zaridze D, Lewington S, Boroda A, et al. Alcohol and mortality in Russia: prospective observational study of 151,000 adults. Lancet. 2014 Apr 26;383(9927):1465-73. doi:10.1016/S0140-6736(13)62247-3.
6. Pinto YM, Elliott PM, Arbustini E, et al. Proposal for a revised definition of dilated cardiomyopathy, hypokinetic non-dilated cardiomyopathy, and its implications for clinical practice: a position statement of the ESC working group on myocardial and pericardial diseases. Eur Heart J. 2016 Jun 14;37(23):1850-8. doi:10.1093/eurheartj/ehv727.
7. Moiseev VS, Nikolaev AY, Garmash IV. Alcohol disease. Injury of internal organs. M.: Geotar-Media, 2014. p. 480. (In Russ.)
8. Rehm J, Hasan OSM, Imtiaz S, Neufeld M. Quantifying the contribution of alcohol to cardiomyopathy: A systematic review. Alcohol. 2017;61:9-15. doi:10.1016/j.alcohol.2017.01.011.
9. Naghavi M, Abajobir AA, Abbafati C, et al. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390:1151-210. doi:10.1016/S0140-6736(17)32152-9.
10. Manthey J, Probst C, Rylett M, Rehm J. National, regional and global mortality due to alcoholic cardiomyopathy in 2015. Heart. 2018 Oct;104(20):1663-9. doi:10.1136/heartjnl-2017-312384.
11. Shield KD, Rylett M, Rehm J. Public health successes and missed opportunities. Trends in alcohol consumption and attributable mortality in the WHO European Region, 1990-2014. Copenhagen, Denmark: WHO European Region, 2016. p. 78.
12. Rehm J, Imtiaz S. A narrative review of alcohol consumption as a risk factor for global burden of disease. Subst Abuse Treat Prev Policy. 2016;11(1):37.
13. Mirijello A, Tarli C, Vassallo GA, et al. Alcoholic cardiomyopathy: What is known and what is not known. Eur J Intern Med. 2017;43:1-5. doi:10.1016/j.ejim.2017.06.014.
14. Whitman IR, Agarwal V, Nah G, et al. Alcohol Abuse and Cardiac Disease. J Am Coll Cardiol. 2017;69(1):13-24. doi:10.1016/j.jacc.2016.10.048.
15. Ram P, Lo KB, Shah M, et al. National trends in hospitalizations and outcomes in patients with alcoholic cardiomyopathy. Clin Cardiol. 2018 Nov;41(11):1423-9. doi:10.1002/clc.23067.
16. Goel S, Sharma A, Garg A. Effect of Alcohol Consumption on Cardiovascular Health. Curr Cardiol Rep. 2018;20(4):19. doi:10.1007/s11886-018-0962-2.
17. Fernández-Solà J. Cardiovascular risks and benefits of moderate and heavy alcohol consumption. Nat Rev Cardiol. 2015;12(10):576-87. doi:10.1038/nrcardio.2015.91.
18. Gonçalves A, Claggett B, Jhund PS, et al. Alcohol consumption and risk of heart failure: the Atherosclerosis Risk in Communities Study. Eur Heart J. 2015;36(15):939-45. doi:10.1093/eurheartj/ehu514.
19. Larsson SC, Orsini N, Wolk A. Alcohol consumption and risk of heart failure: a doseresponse meta-analysis of prospective studies. Eur J Heart Fail. 2015;17(4):367-73. doi:10.1002/ejhf.228.
20. Cosmi F, Di Giulio P, Masson S, et al. Regular wine consumption in chronic heart failure: impact on outcomes, quality of life, and circulating biomarkers. Circ Heart Fail. 2015;8(3):428-37. doi:10.1161/CIRCHEARTFAILURE.114.002091.
21. Stockwell T, Zhao J, Panwar S, et al. Do “Moderate” Drinkers Have Reduced Mortality Risk? A Systematic Review and Meta-Analysis of Alcohol Consumption and All-Cause Mortality. J Stud Alcohol Drugs. 2016;77(2):185-98. doi:10.15288/jsad.2016.77.185.
22. Wood AM, Kaptoge S, Butterworth AS, et al. Risk thresholds for alcohol consumption: combined analysis of individual-participant data for 599 912 current drinkers in 83 prospective studies. Lancet. 2018;391(10129):1513-23. doi:10.1016/S0140-6736(18)30134-X.
23. Larsson SC, Wallin A, Wolk A. Contrasting association between alcohol consumption and risk of myocardial infarction and heart failure: Two prospective cohorts. Int J Cardiol. 2017;231:207-10. doi:10.1016/j.ijcard.2016.12.149.
24. Criqui MH, Thomas IC. Alcohol Consumption and Cardiac Disease: Where Are We Now? J Am Coll Cardiol. 2017;69(1):25-7. doi:10.1016/j.jacc.2016.10.049.
25. Cameli M, Ballo P, Garzia A, et al. Acute effects of low doses of ethanol on left and right ventricular function in young healthy subjects. Alcohol Clin Exp Res. 2011;35:1860-5. doi:10.1111/j.1530-0277.2011.01530.x.
26. Kupari M, Koskinen P. Relation of left ventricular function to habitual alcohol consumption. Am J Cardiol. 1993;72:1418-24. doi:10.1016/0002-9149(93)90190-N.
27. Lange RA, Hillis LD. Cardiomyopathies Induced by Drugs or Toxins In: Zipes D, Libby P, Bonow R, Mann D, Tomaselli G, eds. Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Elsevier, 2018:1631-9. ISBN: 9780323555920.
28. Waszkiewicz N, Szulc A, Zwierz K. Binge drinking-induced subtle myocardial injury. Alcohol Clin Exp Res. 2013;37(8):1261-3. doi:10.1111/acer.12208.
29. Leibing E, Meyer T. Enzymes and signal pathways in the pathogenesis of alcoholic cardiomyopathy. Herz. 2016;41(6):478-83. doi:10.1007/s00059-016-4459-8.
30. González-Reimers E, Santolaria-Fernández F, Martín-González MC, et al. Alcoholism: a systemic proinflammatory condition. World J Gastroenterol. 2014;20(40):14660-71. doi:10.3748/wjg.v20.i40.14660.
31. Sokolova OV. The morphological changes in the myocardial tissue after sudden cardiac death from alcoholic cardiomyopathy. Sud Med Ekspert. 2016;59(1):3-6. (In Russ.) doi:10.17116/sudmed20165913-6.
32. Pirozhkov SV, Panchenko LF. Alcoholic heart disease. Kardiologiia. 2013;53(8):87-92. (In Russ.)
33. Strasser RH, Nüchter I, Rauch B, et al. Changes in cardiac signal transduction systems in chronic ethanol treatment preceding the development of alcoholic cardiomyopathy. Herz. 1996;21(4):232-40.
34. Fernández-Solà J, Planavila Porta A. New Treatment Strategies for Alcohol-Induced Heart Damage. Int J Mol Sci. 2016;17(10):E1651. doi:10.3390/ijms17101651.
35. Piano MR, Phillips SA. Alcoholic cardiomyopathy: pathophysiologic insights. Cardiovasc Toxicol. 2014;14(4):291-308. doi:10.1007/s12012-014-9252-4.
36. Rodriguez A, Chawla K, Umoh NA, et al. Alcohol and Apoptosis: Friends or Foes? Biomolecules. 2015;5(4):3193-203. doi:10.3390/biom5043193.
37. Steiner JL, Lang CH. Etiology of alcoholic cardiomyopathy: Mitochondria, oxidative stress and apoptosis. Int J Biochem Cell Biol. 2017;89:125-135. doi: 10.1016/j.biocel.2017.06.009.
38. Liu B, Zhang R, Wei S, et al. ALDH2 protects against alcoholic cardiomyopathy through a mechanism involving the p38 MAPK/CREB pathway and local renin-angiotensin system inhibition in cardiomyocytes. Int J Cardiol. 2018;257:150-9. doi:10.1016/j.ijcard.2017.11.094.
39. O’Neill D, Britton A, Brunner EJ, Bell S. Twenty-Five-Year Alcohol Consumption Trajectories and Their Association With Arterial Aging: A Prospective Cohort Study. J Am Heart Assoc. 2017;6(2). pii:e005288. doi:10.1161/JAHA.116.005288.
40. Zapico SC, Ubelaker DH. mtDNA Mutations and Their Role in Aging, Diseases and Forensic Sciences. Aging Dis. 2013;4(6):364-80. doi:10.14336/AD.2013.0400364.
41. Ware JS, Amor-Salamanca A, Tayal U, et al. Genetic Etiology for Alcohol-Induced Cardiac Toxicity. J Am Coll Cardiol. 2018;71(20):2293-302. doi:10.1016/j.jacc.2018.03.462.
42. Manolis TA, Manolis AA, Manolis AS. Cardiovascular effects of alcohol: A double-edged sword / how to remain at the nadir point of the J-Curve? Alcohol. 2018;76:117-29. doi:10.1016/j.alcohol.2018.08.011.
43. Tereschenko SN, Zhirov IV, Kotaeva EA, Malichenko. Alcoholic and dilated cardiomyopathies. Is equal sign justified? Kardiologiia. 2008;3:93-6. (In Russ.)
44. Moiseev VS, Shelepin AA. Alcohol and heart disease. M.: Geotar-media, 2019. p. 168. (In Russ.)
45. Moiseev VS, Goncharov AS, Kiyakbaev GK. Immune inflammatory alterations (myocarditis?) in chronic heart failure patients with alcohol abuse. Terapevticheskiy arkhiv. 2013;12(85):27-35. (In Russ.)
46. Vieira BA, Luft VC, Schmidt MI, et al. Timing and Type of Alcohol Consumption and the Metabolic Syndrome — ELSA-Brasil. PLoS One. 2016;11(9):e0163044. doi:10.1371/journal.pone.0163044.
47. Du D, Bruno R, Dwyer T, Venn A, Gall S. Associations between alcohol consumption and cardio-metabolic risk factors in young adults. Eur J Prev Cardiol. 2017;24(18):1967-78. doi:10.1177/2047487317724008.
48. Ruiz-del-Árbol L, Serradilla R. Cirrhotic cardiomyopathy. World J Gastroenterol. 2015;21(41):11502-21. doi:10.3748/wjg.v21.i41.11502.
49. Moiseev VS, Kiyakbaev GK, Lazarev PV. Cardiomyopathies and myocarditis. M.: Geotar-Media, 2018. p. 532. (In Russ.)
50. OECD. Tackling Harmful Alcohol Use: Economics and Public Health Policy. OECD Publishing, 2015. p. 240. ISBN 978-92-64-18106-9. doi:10.1787/9789264181069-en.
51. Probst C, Manthey J, Martinez A, Rehm J. Alcohol use disorder severity and reported reasons not to seek treatment: a cross-sectional study in European primary care practices. Subst Abuse Treat Prev Policy. 2015;10:32. doi:10.1186/s13011-015-0028-z.
52. Manthey J, Gual A, Jakubczyk A, et al. Alcohol use disorders in Europe: A comparison of general population and primary health care prevalence rates. J Subst Use 2016;21:478-84. doi:10.3109/14659891.2015.1063719.
53. Bortolotti F, Sorio D, Bertaso A, Tagliaro F. Analytical and diagnostic aspects of carbohydrate deficient transferrin (CDT): A critical review over years 2007-2017. J Pharm Biomed Anal. 2018;147:2-12. doi:10.1016/j.jpba.2017.09.006.
54. Franzini M, Fornaciari I, Vico T, et al. High-sensitivity γ-glutamyltransferase fraction pattern in alcohol addicts and abstainers. Drug Alcohol Depend. 2013;127(1-3):239-42. doi:10.1016/j.drugalcdep.2012.06.004.
55. Hung CL, Gonçalves A, Lai YJ, et al. Light to moderate habitual alcohol consumption is associated with subclinical ventricular and left atrial mechanical dysfunction in an asymptomatic population: dose-response and propensity analysis. J Am Soc Echocardiogr. 2016;29(11):1043-51.e4. doi:10.1016/j.echo.2016.07.014.
56. Bozkurt B, Colvin M, Cook J, et al. Current diagnostic and treatment strategies for specific dilated cardiomyopathies: a scientific statement from the American heart association. Circulation 2016;134:e579-e646. doi:10.1161/CIR.0000000000000455.
57. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2016;37(27):2129-200. doi:10.1093/eurheartj/ehw128.
58. Guzzo-Merello G, Dominguez F, González-López E, et al. Malignant ventricular arrhythmias in alcoholic cardiomyopathy. Int J Cardiol. 2015;199:99-105. doi:10.1016/j.ijcard.2015.07.029.
59. Opreanu M, Wan C, Singh V, et al. Wearable cardioverter-defibrillator as a bridge to cardiac transplantation: A national database analysis. J Heart Lung Transplant. 2015;34(10):1305-9. doi:10.1016/j.healun.2015.04.004.
60. Fang W, Luo R, Tang Y, et al. The Prognostic Factors of Alcoholic Cardiomyopathy: A single-center cohort study. Medicine (Baltimore). 2018;97(31):e11744. doi:10.1097/MD.0000000000011744.
61. Fauchier L, Babuty D, Poret P, et al. Comparison of long-term outcome of alcoholic and idiopathic dilated cardiomyopathy. Eur Heart J 2000;21:306-14. doi:10.1053/euhj.1999.1761.
62. Gavazzi A, De Maria R, Parolini M, Porcu M. Alcohol abuse and dilated cardiomyopathy in men. Am J Cardiol 2000;85:1114-8. doi:10.1016/S0002-9149(00)00706-2.
63. Fernández Solà J. Reversibility of Alcohol Dilated Cardiomyopathy. Rev Esp Cardiol (Engl Ed). 2018;71(8):603-5. doi:10.1016/j.rec.2018.01.016.
64. Guzzo-Merello G, Segovia J, Dominguez F, et al. Natural history and prognostic factors in alcoholic cardiomyopathy. JACC Heart Fail. 2015 Jan;3(1):78-86. doi:10.1016/j.jchf.2014.07.014.
65. Amor-Salamanca A, Guzzo-Merello G, González-López E, et al. Prognostic Impact and Predictors of Ejection Fraction Recovery in Patients With Alcoholic Cardiomyopathy. Rev Esp Cardiol (Engl Ed). 2018;71(8):612-9. doi:10.1016/j.rec.2017.11.032.
66. Zaridze D. Alcohol and health in Russia: good news at last. Lancet. 2017;390(10102):1616-8. doi:10.1016/S0140-6736(17)32387-5.
67. Kryzhanovskii SA, Kolik LG, Tsorin IB, et al. Alcoholic Cardiomyopathy: Translation Model. Bulletin of Experimental Biology and Medicine. 2017;163:627-31. doi:10.1007/s10517-017-3865-0.
68. Tu X, Wang C, Ru X, et al. Therapeutic effects of rapamycin on alcoholic cardiomyopathy. Exp Ther Med. 2017;14(4):2763-70. doi:10.3892/etm.2017.4901.
Review
For citations:
Kobalava Zh.D., Lazarev P.V., Goncharov A.S. A modern view on the pathogenesis, diagnosis and treatment of alcoholic cardiomyopathy. Russian Journal of Cardiology. 2019;(11):164-172. (In Russ.) https://doi.org/10.15829/1560-4071-2019-11-164-172
Views:
6717
Email this article 