Prognostic significance of myocardial fibrosis in men with alcoholic cardiomyopathy: insights from cardiac MRI.

OBJECTIVES

Myocardial fibrosis significantly impacts prognosis in various cardiovascular diseases, yet its role in alcoholic cardiomyopathy (ACM) remains poorly understood. This study evaluates the prognostic value of myocardial fibrosis, as detected by cardiac magnetic resonance (CMR), in ACM patients.

METHODS

We conducted a retrospective analysis of consecutive ACM patients who underwent enhanced CMR from August 2015 to October 2023. Assessment of myocardial fibrosis was performed using late gadolinium enhancement (LGE), native T1, and extracellular volume (ECV) fraction. The primary outcome was a composite of cardiac-related mortality, heart transplantation, hospitalization for heart failure, life-threatening arrhythmias, and the need for implantable cardioverter-defibrillator or cardiac resynchronization therapy.

RESULTS

A total of 141 male patients were finally enrolled with 27.7% experiencing the primary outcome over a median follow-up of 30.6 months (IQR: 18.0-44.9). LGE was found in 55.3% of patients, with a median extent of 2.9%. Compared to DCM patients who didn't consume alcohol, ACM patients showed lower LGE, native T1, and ECV values. Multivariate analysis showed LGE (HR, 1.09 [1.04, 1.15]; p < 0.001), native T1 (per 10 ms increase, 1.06 [1.02, 1.10]; p = 0.003), and ECV (per 3% increase, 1.57 [1.22, 2.01]; p < 0.001) had significant prognostic associations with adverse outcomes. Including myocardial fibrosis parameters improved predictive accuracy beyond standard assessments. A nonlinear relationship was found between lifetime ethanol consumption and myocardial fibrosis, with a plateau at low exposures and a sharp increase at higher levels.

CONCLUSION

CMR-identified myocardial fibrosis has an association with major adverse cardiac events in ACM patients, underscoring its utility in risk stratification.

KEY POINTS

Question The prognostic role of myocardial fibrosis in alcoholic cardiomyopathy remains poorly understood. Findings Fibrosis detected by cardiac MRI has good incremental value for predictive models in assessing the risk of adverse cardiovascular events in patients with alcoholic cardiomyopathy. Clinical relevance Cardiac MRI may be a potential tool to identify high-risk alcoholic cardiomyopathy patients with cardiovascular adverse event, which is helpful for early clinical treatment, and improves patients prognosis.