Comparison of long-term outcome of alcoholic and idiopathic dilated cardiomyopathy

Aims The outcome of alcoholic cardiomyopathy is thought to be better than i diopathic dilated cardiomyopathy if patients abstain from alcohol. The aim of this study was to compare the long-term clinical outcome of alcoholic an d idiopathic dilated cardiomyopathy. Methods and Results Of 134 patients with dilated cardiomyopathy and normal coronary angiography, 50 had alcoholic cardiomyopathy: they were compared s erially to 84 patients with idiopathic dilated cardiomyopathy. Left ventric ular end-diastolic diameter, left ventricular ejection fraction and cardiac index, severity of ventricular arrhythmias. measurement of heart rate vari ability and results of signal-averaged ECG were similar in both groups. Alt hough alcohol withdrawal was strongly recommended but observed in only 70% of patients with alcoholic cardiomyopathy. both groups had similar outcome in terms of cardiac death after follow-up treatment of 47 +/- 40 months. Mu ltivariate analysis in the entire cohort demonstrated that increased pulmon ary capillary wedge pressure (P=0.003), alcoholism and lack of abstinence d uring follow-up (P=0.006) and decreased standard deviation of all normal-to -normal RR intervals (P=0.02) were independent predictors of cardiac death. Conclusion In contrast with previous studies, patients with alcoholic cardi omyopathy did not have a better outcome than patients with idiopathic dilat ed cardiomyopathy. Alcoholism without abstinence was a strong predictor of cardiac death. This suggests that a more aggressive approach to alcohol ces sation is needed in these patients. (C) 2000 The European Society of Cardio logy.