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From the data provided in the available ACM studies, it appears that patients who received an ACEI globally showed improved prognosis. In contrast, beta-blockers, similar to aldosterone inhibitors, however beneficial they may be, have thus far not yielded sufficient data on their efficacy in relation to this disease. In the second study, Gavazzi led a multicentre alcoholic cardiomyopathy is especially dangerous because study in which, from 1986 to 1995, 79 patients with ACM and 259 patients with DCM were recruited[10]. Transplant-free survival after 7 years was worse among patients with ACM than among those with DCM (41% vs 53%). Among patients who continued drinking heavily, transplant-free survival was significantly worse than in non-drinkers (27% vs 45%).

Although anticoagulation may be of benefit to patients with profound LV dysfunction and atrial fibrillation, the risks must be weighed heavily in this patient population. Electrocardiographic findings are frequently abnormal, and these findings may be the only indication of heart disease in asymptomatic patients. A 12-month observational study of 20 patients with AC noted smaller cavity diameters, better clinical evaluation findings, and fewer hospitalizations in the 10 patients who abstained from alcohol use. Basic research studies have described an abundance of mechanisms that could underscore the functional and structural alterations found in ACM. Because of this, their origin could be multifactorial and linked both to the alcohol molecule and to its main metabolite, acetaldehyde.

Alcoholic Cardiomyopathy: Pathogenic Aspects

Germany with a total population of 81 million inhabitants is a permissive society with respect to the drinking of alcohol. The per capita alcohol consumption of 9.7 l pure ethanol and the early onset of regular or episodic intensive drinking among young people in Germany consequently leads to high alcohol-related morbidity and mortality [5]. ACM weakens the heart’s ability to pump blood effectively, leading to heart failure. Because oxygen and nutrients cannot reach all areas of the body that demand them, symptoms like fatigue, shortness of breath, and fluid retention develop quickly.

Askanas et al[21] found a significant increase in the myocardial mass and of the pre-ejection periods in drinkers of over 12 oz of whisky (approximately 120 g of alcohol) compared to a control group of non-drinkers. However, no differences were found in these parameters between the sub-group of individuals who had been drinking for 5 to 14 years and the sub-group of individuals who had a drinking history of over 15 years. Kino et al[22] found increased ventricular thickness when consumption exceeded 75 mL/d (60 g) of ethanol, and the increase was higher among those subjects who consumed over 125 mL/d (100 g), without specifying the duration of consumption. In another study on this topic, Lazarević et al[23] divided a cohort of 89 asymptomatic individuals whose consumption exceeded 80 g/d (8 standard units) into 3 groups according to the duration of their alcohol abuse. Subjects with a shorter period of alcohol abuse, from 5 to 10 years, had a significant increase in left ventricular diameter and volume compared to the control group. However, a systolic impairment was not found as the years of alcoholic abuse continued.

Is there an immediate risk of alcohol intake?

Certain populations are more vulnerable to ACM, such as middle-aged and older adults, as the risk of developing cardiac issues generally increases with age. Hypertrophic cardiomyopathy is a condition where the heart muscle walls are thickened. “Alcoholic cardiomyopathy is a very serious disease with significant implications,” says Patel. It is a form of dilated cardiomyopathy, where the muscular walls of the heart’s ventricles (pumping chambers) are weakened.

Investigating the mechanisms, consequences, and potential treatment options for ACM remains a very important area of research. Biomarkers of heart failure such as NT-proBNP and of myocardial necrosis such as the troponins and CKMB indicate heart failure or myocytolysis. In his 1972 review article, Bridgen was the first to introduce the term alcoholic cardiomyopathy [27]. This review assembles and selects pertinent literature on the ambivalent relationship of ethanol and the cardiovascular system, including guidelines, meta-analyses, Cochrane reviews, original contributions, and data from the Marburg Cardiomyopathy registry. In cases of ACM where heart damage is substantial, a heart transplant may be considered. This is considered a last-resort treatment option only after other treatments have proven unsuccessful.