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. 2001 Oct;86(4):417–423. doi: 10.1136/heart.86.4.417

Dose dependent but non-linear effects of alcohol on the left and right ventricle

O Kajander 1, M Kupari 1, P Laippala 1, V Savolainen 1, J Pajarinen 1, A Penttila 1, P Karhunen 1
PMCID: PMC1729926  PMID: 11559683

Abstract

OBJECTIVE—To assess how left (LV) and right ventricular (RV) size, wall thickness, and mass depend on daily alcohol consumption. Among alcoholics, most common findings have been LV hypertrophy and mild systolic or diastolic dysfunction, accompanied occasionally by ventricular dilatation resembling dilated cardiomyopathy. Although it is commonly agreed that chronic heavy alcohol use is injurious to the heart, the dose-injury relation remains a matter of dispute.
DESIGN—Prospective series of 700 Finnish men aged 33-70 years who died out of hospital and underwent a medicolegal necropsy.
METHODS AND RESULTS—Data on alcohol use and other risk factors were obtained from the spouse. At necropsy, a transversal slice of the heart was traced on a transparent sheet and analysed later for LV and RV cavity areas and wall thicknesses. Coronary artery stenoses were measured from silicone casts of the arteries. In analyses of all men, daily alcohol dose predicted heart weight (β = 0.17, p < 0.001) and RV cavity area (β = 0.14, p = 0.007) independent of body size, age, coronary artery disease, hypertension, diabetes, and smoking. In the subgroup of men free of significant coronary artery disease, LV area averaged (SEM) 11.0 (1.0) cm2 in men drinking < 12 g/day, 7.7 (0.7) cm2 in those drinking 72-180 g/day, and 10.0 (0.9) cm2 in those drinking > 180 g/day (p = 0.054). Very heavy drinking (> 180 g/day) was associated with an increase in RV cavity area (p = 0.005).
CONCLUSIONS—The effects of alcohol on the heart in middle aged men are dose dependent but partly non-linear. In the absence of coronary artery disease, LV size shows a U shaped reduction with increasing daily alcohol use accompanied by an increase in RV size with very heavy drinking. These findings question the idea of progressive LV dilatation with increasing alcohol consumption among male victims of sudden death.


Keywords: alcohol; cardiomyopathy; remodelling; sudden death

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Figure 1  .

Figure 1  

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Drawing showing the location of the cardiac slice selected for the border tracing and later analyses. The measurements were of the right ventricular cavity area (a), left ventricular cavity area (b), left ventricular anterior wall thickness (c), and left ventricular posterior wall thickness (d).

Figure 2  .

Figure 2  

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Flow chart showing the number of men included in the different analyses.

Figure 3  .

Figure 3  

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Left (LV) and right ventricular (RV) cavity areas (mean (SD)) according to daily alcohol consumption in men free of coronary artery disease and myocardial infarction at necropsy. *From analysis of covariance. †Scheffé's post hoc test.

Figure 4  .

Figure 4  

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LV posterior wall to cavity area ratio according to daily alcohol consumption in men free of coronary artery disease and myocardial infarction at necropsy. *From analysis of covariance. †Scheffé's post hoc test.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ahmed S. S., Levinson G. E., Fiore J. J., Regan T. J. Spectrum of heart muscle abnormalities related to alcoholism. Clin Cardiol. 1980 Oct;3(5):335–341. doi: 10.1002/clc.4960030408. [DOI] [PubMed] [Google Scholar]
  2. Askanas A., Udoshi M., Sadjadi S. A. The heart in chronic alcoholism: a noninvasive study. Am Heart J. 1980 Jan;99(1):9–16. doi: 10.1016/0002-8703(80)90309-9. [DOI] [PubMed] [Google Scholar]
  3. Dancy M., Bland J. M., Leech G., Gaitonde M. K., Maxwell J. D. Preclinical left ventricular abnormalities in alcoholics are independent of nutritional status, cirrhosis, and cigarette smoking. Lancet. 1985 May 18;1(8438):1122–1125. doi: 10.1016/s0140-6736(85)92431-6. [DOI] [PubMed] [Google Scholar]
  4. Estruch R., Nicolás J. M., Villegas E., Junqué A., Urbano-Márquez A. Relationship between ethanol-related diseases and nutritional status in chronically alcoholic men. Alcohol Alcohol. 1993 Sep;28(5):543–550. [PubMed] [Google Scholar]
  5. Fleming M. F., Barry K. L., MacDonald R. The alcohol use disorders identification test (AUDIT) in a college sample. Int J Addict. 1991 Nov;26(11):1173–1185. doi: 10.3109/10826089109062153. [DOI] [PubMed] [Google Scholar]
  6. Gavazzi A., Berzuini C., Campana C., Inserra C., Ponzetta M., Sebastiani R., Ghio S., Recusani F. Value of right ventricular ejection fraction in predicting short-term prognosis of patients with severe chronic heart failure. J Heart Lung Transplant. 1997 Jul;16(7):774–785. [PubMed] [Google Scholar]
  7. Juillière Y., Barbier G., Feldmann L., Grentzinger A., Danchin N., Cherrier F. Additional predictive value of both left and right ventricular ejection fractions on long-term survival in idiopathic dilated cardiomyopathy. Eur Heart J. 1997 Feb;18(2):276–280. doi: 10.1093/oxfordjournals.eurheartj.a015231. [DOI] [PubMed] [Google Scholar]
  8. Karhunen P. J., Penttilä A. Validity of post-mortem alcohol reports. Alcohol Alcohol. 1990;25(1):25–32. [PubMed] [Google Scholar]
  9. Kettunen R., Timisjärvi J., Saukko P., Koskela M. Influence of ethanol on systemic and pulmonary hemodynamics in anesthetized dogs. Acta Physiol Scand. 1983 Jul;118(3):209–214. doi: 10.1111/j.1748-1716.1983.tb07264.x. [DOI] [PubMed] [Google Scholar]
  10. Kettunen R., Timisjärvi J., Saukko P. The acute dose-related effects of ethanol on right ventricular function in anesthetized dogs. Alcohol. 1992 Mar-Apr;9(2):149–153. doi: 10.1016/0741-8329(92)90026-7. [DOI] [PubMed] [Google Scholar]
  11. Kino M., Imamitchi H., Morigutchi M., Kawamura K., Takatsu T. Cardiovascular status in asymptomatic alcoholics, with reference to the level of ethanol consumption. Br Heart J. 1981 Nov;46(5):545–551. doi: 10.1136/hrt.46.5.545. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Koskinen P., Kupari M., Nieminen M. S., Suokas A., Tötterman K., Pajari R., Heikkilä J. Effects of alcohol on systemic and pulmonary hemodynamics in normal humans. Clin Cardiol. 1986 Oct;9(10):479–482. doi: 10.1002/clc.4960091002. [DOI] [PubMed] [Google Scholar]
  13. Kupari M., Koskinen P. Alcohol, cardiac arrhythmias and sudden death. Novartis Found Symp. 1998;216:68–85. doi: 10.1002/9780470515549.ch6. [DOI] [PubMed] [Google Scholar]
  14. Kupari M., Koskinen P. Comparison of the cardiotoxicity of ethanol in women versus men. Am J Cardiol. 1992 Sep 1;70(6):645–649. doi: 10.1016/0002-9149(92)90206-e. [DOI] [PubMed] [Google Scholar]
  15. Kupari M., Koskinen P., Suokas A. Left ventricular size, mass and function in relation to the duration and quantity of heavy drinking in alcoholics. Am J Cardiol. 1991 Feb 1;67(4):274–279. doi: 10.1016/0002-9149(91)90559-4. [DOI] [PubMed] [Google Scholar]
  16. Kupari M., Koskinen P., Suokas A., Ventilä M. Left ventricular filling impairment in asymptomatic chronic alcoholics. Am J Cardiol. 1990 Dec 15;66(20):1473–1477. doi: 10.1016/0002-9149(90)90537-b. [DOI] [PubMed] [Google Scholar]
  17. La Vecchia L., Paccanaro M., Bonanno C., Varotto L., Ometto R., Vincenzi M. Left ventricular versus biventricular dysfunction in idiopathic dilated cardiomyopathy. Am J Cardiol. 1999 Jan 1;83(1):120-2, A9. doi: 10.1016/s0002-9149(98)00795-4. [DOI] [PubMed] [Google Scholar]
  18. Lundin L., Hällgren R., Landelius J., Roxin L. E., Venge P. Myocardial and skeletal muscle function in habitual alcoholics and its relation to serum myoglobin. Am J Cardiol. 1986 Oct 1;58(9):795–799. doi: 10.1016/0002-9149(86)90356-5. [DOI] [PubMed] [Google Scholar]
  19. Manolio T. A., Levy D., Garrison R. J., Castelli W. P., Kannel W. B. Relation of alcohol intake to left ventricular mass: The Framingham Study. J Am Coll Cardiol. 1991 Mar 1;17(3):717–721. doi: 10.1016/s0735-1097(10)80189-5. [DOI] [PubMed] [Google Scholar]
  20. Mathews E. C., Jr, Gardin J. M., Henry W. L., Del Negro A. A., Fletcher R. D., Snow J. A., Epstein S. E. Echocardiographic abnormalities in chronic alcoholics with and without overt congestive heart failure. Am J Cardiol. 1981 Mar;47(3):570–578. doi: 10.1016/0002-9149(81)90540-3. [DOI] [PubMed] [Google Scholar]
  21. Pajarinen J., Laippala P., Penttila A., Karhunen P. J. Incidence of disorders of spermatogenesis in middle aged finnish men, 1981-91: two necropsy series. BMJ. 1997 Jan 4;314(7073):13–18. doi: 10.1136/bmj.314.7073.13. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Savolainen V. T., Liesto K., Männikkö A., Penttilä A., Karhunen P. J. Alcohol consumption and alcoholic liver disease: evidence of a threshold level of effects of ethanol. Alcohol Clin Exp Res. 1993 Oct;17(5):1112–1117. doi: 10.1111/j.1530-0277.1993.tb05673.x. [DOI] [PubMed] [Google Scholar]
  23. Selzer M. L. Michigan Alcoholism Screening Test (MAST): preliminary report. Univ Mich Med Cent J. 1968 May-Jun;34(3):143–145. [PubMed] [Google Scholar]
  24. Silberbauer K., Juhasz M., Ohrenberger G., Hess C. Noninvasive assessment of left ventricular diastolic function by pulsed Doppler echocardiography in young alcoholics. Cardiology. 1988;75(6):431–439. doi: 10.1159/000174413. [DOI] [PubMed] [Google Scholar]
  25. Spodick D. H., Pigott V. M., Chirife R. Preclinical cardiac malfunction in chronic alcoholism. Comparison with matched normal controls and with alcoholic cardiomyopathy. N Engl J Med. 1972 Oct 5;287(14):677–680. doi: 10.1056/NEJM197210052871401. [DOI] [PubMed] [Google Scholar]
  26. Thomas G., Haider B., Oldewurtel H. A., Lyons M. M., Yeh C. K., Regan T. J. Progression of myocardial abnormalities in experimental alcoholism. Am J Cardiol. 1980 Aug;46(2):233–241. doi: 10.1016/0002-9149(80)90063-6. [DOI] [PubMed] [Google Scholar]
  27. Tunstall-Pedoe H., Kuulasmaa K., Mähönen M., Tolonen H., Ruokokoski E., Amouyel P. Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortality: 10-year results from 37 WHO MONICA project populations. Monitoring trends and determinants in cardiovascular disease. Lancet. 1999 May 8;353(9164):1547–1557. doi: 10.1016/s0140-6736(99)04021-0. [DOI] [PubMed] [Google Scholar]
  28. Tunstall-Pedoe H. Monitoring trends in cardiovascular disease and risk factors: the WHO "Monica" project. WHO Chron. 1985;39(1):3–5. [PubMed] [Google Scholar]
  29. Urbano-Marquez A., Estruch R., Navarro-Lopez F., Grau J. M., Mont L., Rubin E. The effects of alcoholism on skeletal and cardiac muscle. N Engl J Med. 1989 Feb 16;320(7):409–415. doi: 10.1056/NEJM198902163200701. [DOI] [PubMed] [Google Scholar]
  30. Urbano-Márquez A., Estruch R., Fernández-Solá J., Nicolás J. M., Paré J. C., Rubin E. The greater risk of alcoholic cardiomyopathy and myopathy in women compared with men. JAMA. 1995 Jul 12;274(2):149–154. doi: 10.1001/jama.1995.03530020067034. [DOI] [PubMed] [Google Scholar]
  31. Weman S. M., Salminen U. S., Penttilä A., Männikkö A., Karhunen P. J. Post-mortem cast angiography in the diagnostics of graft complications in patients with fatal outcome following coronary artery bypass grafting (CABG). Int J Legal Med. 1999;112(2):107–114. doi: 10.1007/s004140050211. [DOI] [PubMed] [Google Scholar]

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