PREDICTION OF RECOVERY AFTER ABSTINENCE IN ALCOHOLIC CARDIOMYOPATHY -ROLE OF HEMODYNAMIC AND MORPHOMETRIC PARAMETERS

The aim of the study is to describe the hemodynamic and morphometric c haracteristics of patients with alcoholic cardiomyopathy (ACM) and to evaluate whether these parameters can identify the subgroup of patient s in whom recovery of cardiac function after abstinence will occur. Ni neteen male patients (mean age 52.4 years, range 39-64 years) with sym ptomatic left ventricular dysfunction (LVD) [ejection fraction (EF) <5 0%] and a history of chronic heavy alcohol intake were submitted to a full invasive work-up including right ventricular endomyocardial biops y (EMB). Counseling aimed at obtaining abstention and clinical follow- up were regularly performed in all patients, The two requisites necess ary to define recovery were (1) an increase in left ventricular EF, an d (2) improvement of symptoms. The former was defined as a gain in lef t ventricular EF>15% from baseline; the latter, as a gain of at least one New York Heart Association (NYHA) functional class. Using these cr iteria, 9 alcoholic patients (48%) (Group A) improved significantly, w hile 10 (52%) (Group B) either stabilized or deteriorated at 2 years' follow-up. Group A patients had significantly lower pulmonary artery m ean pressure (27.8 mmHg +/- 13.3 vs, 40.3 mmHg +/- 12.4; p < 0.05) and pulmonary capillary wedge pressure (18.4 mmHg +/- 8.9 vs. 26.5 mmHg /- 7.7; p < 0.05) compared with Group B. All other hemodynamic data di d not show statistically significant differences in the two groups. Qu antitative evaluation of myocardial hypertrophy and interstitial fibro sis performed on EMB tissue samples using the morphometric approach wa s not predictive of recovery. Improvement in cardiac performance and f unctional class was detected in about one-half of patients with ACM wh o abstained from alcohol, and occurred even in cases presenting with s evere LVD. Recovery is associated with significantly lower pulmonary a rtery and pulmonary wedge pressures. The morphometric evaluation of EM B does not provide adjunctive prognostic information in these patients .