ALCOHOLIC CARDIOMYOPATHY AND CARDIAC TRAN SPLANTATION

The recognition of alcoholic cardiomyopathy in patients with dilated c ardiomyopathy is essential as they may regress, at least partially, in a relatively short period, with abstention. The clinical history is t he key to diagnosis because no other specific feature can identify the cause. Between January 1984 and July 1995, 26 candidates far cardiac transplantation with dilated cardiomyopathy and chronic alcoholism imp roved after withdrawal of alcohol. None of these patients was placed o n the surgical waiting list. Patients with ischaemic cardiomyopathy. v alvular disease or previous surgery for valvular hypertensive or conge nital heart disease, documented viral myocarditis or connective tissue diseases, were excluded. The diagnostic criterion of chronic alcoholi sm was a total alcohol consumption of 292 kg and a duration of alcohol abuse of over 10 years. In addition to the clinical features, biologi cal, electrocardiographic, echocardiographic and haemodynamic paramete rs were analysed. The mean age of the patients was 48 +/- 8 years. The re were 25 men and 1 woman. The total mean alcohol consumption was 1 4 92 kg. The average follow-up period was 63 +/- 41 months. The interval between the onset of symptoms and abstention was 25 months. Haemodyna mic improvement was observed in 25 cases. The average interval between alcoholic abstention and recovery was 11.7 months. One patient died s uddenly. Improvement of symptoms, decrease of the cardiothoracic ratio and improvement of echocardiographic parameters were statistically si gnificant. The increase in angiographic or isotopic ejection fraction and cardiac index and the decrease in mean pulmonary artery pressures were also statistically significant. These results confirmed the diagn osis of alcoholic cardiomyopathy. Therefore, patients with chronic alc ohol abuse and dilated cardiomyopathy must be identified and treated f or this problem and not placed on the waiting list for cardiac transpl antation unless no improvement is observed after about 3 months of abs tention.