Coignard E, Blanchard B, Jault F, Dorent R, Vaissier E, Nataf P, Fontanel M, Gandjbakhch I
Service de chirurgie thoracique et cardiovasculaire, hôpital La Pitié-Salpêtrière, Paris.
Arch Mal Coeur Vaiss. 1998 Jan;91(1):45-51.
The recognition of alcoholic cardiomyopathy in patients with dilated cardiomyopathy is essential as they may regress, at least partially in a relatively short period, with abstention. The clinical history is the key to diagnosis because no other specific feature can identify the cause. Between January 1984 and July 1995, 26 candidates for cardiac transplantation with dilated cardiomyopathy and chronic alcoholism improved after withdrawal of alcohol. None of these patients was placed on the surgical waiting list. Patients with ischaemic cardiomyopathy, valvular disease or previous surgery for valvular hypertensive or congenital heart disease, documented viral myocarditis or connective tissue diseases, were excluded. The diagnostic criterion of chronic alcoholism was a total alcohol consumption of 292 kg and a duration of alcohol abuse of over 10 years. In addition to the clinical features, biological, electrocardiographic, echocardiographic and haemodynamic parameters were analysed. The mean age of the patients was 48 +/- 8 years. There were 25 men and 1 woman. The total mean alcohol consumption was 1,492 kg. The average follow-up period was 63 +/- 41 months. The interval between the onset of symptoms and abstention was 25 months. Haemodynamic improvement was observed in 25 cases. The average interval between alcoholic abstention and recovery was 11.7 months. One patient died suddenly. Improvement of symptoms, decrease of the cardiothoracic ratio and improvement of echocardiographic parameters were statistically significant. 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 diagnosis of alcoholic cardiomyopathy. Therefore, patients with chronic alcohol abuse and dilated cardiomyopathy must be identified and treated for this problem and not placed on the waiting list for cardiac transplantation unless no improvement is observed after about 3 months of abstention.
认识到扩张型心肌病患者中的酒精性心肌病至关重要，因为戒酒的话他们可能会在相对较短的时间内至少部分地病情好转。临床病史是诊断的关键，因为没有其他特定特征能够明确病因。1984年1月至1995年7月期间，26例患有扩张型心肌病且慢性酗酒的心脏移植候选者在戒酒之后病情有所改善。这些患者均未被列入手术等候名单。患有缺血性心肌病、瓣膜病或既往有瓣膜性高血压或先天性心脏病手术史、有记录的病毒性心肌炎或结缔组织病的患者被排除在外。慢性酗酒的诊断标准为总酒精摄入量达292千克且酗酒持续时间超过10年。除了临床特征外，还对生物学、心电图、超声心动图和血流动力学参数进行了分析。患者的平均年龄为48±8岁。有25名男性和1名女性。总平均酒精摄入量为1492千克。平均随访期为63±41个月。症状出现与戒酒之间的间隔为25个月。25例观察到血流动力学改善。戒酒与恢复之间的平均间隔为11.7个月。1例患者突然死亡。症状改善、心胸比率降低以及超声心动图参数改善具有统计学意义。血管造影或同位素射血分数及心脏指数增加以及平均肺动脉压降低也具有统计学意义。这些结果证实了酒精性心肌病的诊断。因此，必须识别并治疗慢性酒精滥用和扩张型心肌病患者的这一问题，除非在戒酒约3个月后未观察到改善，否则不应将其列入心脏移植等候名单。
