DIFFERENCES OF DISEASE PROGRESSION IN CONGESTIVE-HEART-FAILURE DUE TOALCOHOLIC AS COMPARED TO IDIOPATHIC DILATED CARDIOMYOPATHY

In patients with alcoholic cardiomyopathy there is evidence that mild heart failure is reversible if patients abstain from alcohol, but ther e is no consensus whether the disease is progressive once structural m yocardial dilatation has evolved. The aim of the present study was to compare the long-term course of congestive heart failure due to alcoho lic and idiopathic dilated cardiomyopathy. Of 75 patients with overt c ongestive heart failure, 23 had alcoholic cardiomyopathy and were comp ared to 52 patients with idiopathic cardiomyopathy. The mean age was 4 8 +/- 12 years. Despite medical therapy, heart failure class New York Heart Association III-IV was present in 52% of patients with alcoholic and 47% of patients with idiopathic cardiomyopathy (not significant). Their mean left ventricular ejection fraction was 30 +/- 12% vs 28 +/ - 12% and left ventricular end-diastolic volumes were 264 +/- 125 ml a nd 254 +/- 100 ml respectively (not significant). Overall survival at 1, 5 and 10 years was 100%, 81% and 81% for the group with alcoholic d ilated cardiomyopathy and 89%, 48% and 30% for the group with idiopath ic cardiomyopathy, respectively (P = 0.041), and the difference was ev en greater for transplant-free survival P = 0.005). Clinical and invas ive signs of left and right heart failure as well as left ventricular dimensions were predictive of a fatal outcome; however, symptom durati on and left ventricular volumes were only predictive in patients with idiopathic cardiomyopathy, suggesting that in the two patient groups d ifferent mechanisms may lead to death. Mortality in patients with seve re congestive heart failure and left ventricular dilatation due to alc oholic cardiomyopathy is significantly lower than that in patients wit h idiopathic cardiomyopathy and similar degrees of heart failure. Thus , despite structural changes inherent in marked left ventricular dilat ation, disease progression in alcoholic dilated cardiomyopathy is diff erent from that in idiopathic cardiomyopathy and thus may have implica tions for the choice of therapy.