Schröder Jörg, Hamada Sandra, Altiok Ertunc, Almalla Mohammad, Koutziampasi Chrysoula, Napp Andreas, Keszei András, Hein Marc, Becker Michael
Department of Cardiology, RWTH University Hospital, Aachen, Germany.
Medical Informatics, RWTH University Hospital, Aachen, Germany.
J Am Soc Echocardiogr. 2017 Mar;30(3):235-243.e1. doi: 10.1016/j.echo.2016.12.009.
The effects of acute excessive alcohol ingestion on echocardiographic parameters of left ventricular (LV) function are unclear.
One hundred ninety-nine healthy subjects (44 ± 5 years, 71% male) were prospectively examined within 6 hours after excessive alcohol ingestion as well as after 4 weeks with strict alcohol abstinence. Echocardiography was performed at baseline and follow-up for conventional parameters (left ventricular ejection fraction [LVEF], transmitral E and A Doppler flow velocities, E/A ratio, tissue Doppler velocity lateral and septal (é), E/é ratio, deceleration time of E, and isovolumic relaxation time) and myocardial deformation data (such as global radial and global and layer-specific circumferential [endo and epi global CS] and longitudinal [endo and epi global LS] strain). Multivariate regression was used to assess the impact of independent variables on echocardiographic parameters.
Alcohol levels were 1.2 ± 0.3 g/L at the time of drinking cessation. After alcohol ingestion endo CS (30% ± 2% vs 37% ± 3%, P = .008) and endo LS (27% ± 4% vs 33% ± 3%, P = .002) were significantly lower at baseline versus follow-up. Blood pressure, LVEF and heart rate, and other echocardiographic parameters did not differ between the two examinations. Alcohol levels were modestly, negatively associated with change in endo CS and endo LS (r = -0.54, 95% CI, -0.63 to -0.43, P < .001; and r = -0.26, 95% CI, -0.39 to -0.14; P < .003, respectively). Alcohol levels were the strongest predictor for endo CS (β = -4.84; 95% CI, -6.31 to -3.37) and endo LS (β = -2.50; 95% CI, -4.32 to -0.68).
Acute alcohol ingestion effects endocardial CS and LS, suggesting an acute and transient toxic effect on myocardial deformation, an effect that remains undetected by conventional echocardiographic parameters. The current findings may help clinicians to gain more understanding into the mechanism of developing an alcohol cardiomyopathy and to detect early persistent alcohol-induced myocardial disturbances for an effective therapy in time to prevent harm.
急性过量饮酒对左心室（LV）功能超声心动图参数的影响尚不清楚。
199名健康受试者（44±5岁，71%为男性）在过量饮酒后6小时内以及严格戒酒4周后进行前瞻性检查。在基线和随访时进行超声心动图检查，测量常规参数（左心室射血分数[LVEF]、二尖瓣E和A多普勒血流速度、E/A比值、组织多普勒速度侧壁和室间隔（é）、E/é比值、E减速时间和等容舒张时间）以及心肌变形数据（如整体径向、整体和各层特定圆周[内膜和外膜整体圆周应变（CS）]和纵向[内膜和外膜整体纵向应变（LS）]）。采用多变量回归评估自变量对超声心动图参数的影响。
戒酒时酒精浓度为1.2±0.3 g/L。饮酒后，基线时内膜CS（30%±2%对37%±3%，P = 0.008）和内膜LS（27%±4%对33%±3%，P = 0.002）显著低于随访时。两次检查之间血压、LVEF和心率以及其他超声心动图参数无差异。酒精浓度与内膜CS和内膜LS的变化呈适度负相关（r = -0.54，95%CI，-0.63至-0.43，P < 0.001；r = -0.26，95%CI，-0.39至-0.14；P < 0.003）。酒精浓度是内膜CS（β = -4.84；95%CI，-6.31至-3.37）和内膜LS（β = -2.50；95%CI，-4.32至-0.68）的最强预测因子。
急性饮酒影响心内膜CS和LS，提示对心肌变形有急性和短暂的毒性作用，这种作用通过传统超声心动图参数无法检测到。目前的研究结果可能有助于临床医生更深入地了解酒精性心肌病的发病机制，并及时发现早期持续性酒精引起的心肌紊乱，以便进行有效治疗，防止损害。
