The impact of chronic alcohol overuse on heart function and prognosis: Layer-specific longitudinal strain and mid-term outcome analysis

Abstract

Background: The exact effects of alcohol drinking on cardiac function are not clear. Aims: This study aimed to determine the relationship between consumed amount of alcohol, myocardial injury, and prognosis. Methods: Myocardial function and cardiac outcomes were examined in subjects with chronic alcoholism by classical and strain echocardiographic parameters, including global (GLS) and layer-specific longitudinal strain of the endocardial (GLSendo) and epicardial (GLSepi) layer. One group of 65 alcohol-overusers (ALC), median (IQR, interquartile range) age 44 (38-51) years, was compared with 30 controls (CG). Results: Median (IQR) alcohol dose (in alcohol units, 1 AU = 1 g of ethanol) per week was 30 (12-51) AU in ALC and 0 in CG; P <0.001, and the mean (SD, standard deviation) drinking period was 16 (9) years. ALC patients demonstrated higher left ventricular (LV) mass and impaired diastolic function. The ALC group demonstrated lower median (IQR) LV ejection fraction (EF): 52% (37%-57%) vs 60% (55%-63%) (P <0.001); GLS: 17% (9%-20%) vs 19% (18%-21%) (P = 0.01); absolute layer-specific strain values. GLSendo <19% and GLSepi <15% predicted worsened mid-term prognosis, as did elevated N-terminal brain natriuretic peptide (NT-proBNP) and lower EF and GLS. Conclusions: Long-term alcohol overuse, even with a rather low reported median (IQR) dose of 4 (2-7) AU per day resulted in LV hypertrophy, diastolic and systolic dysfunction. Diminished GLS <18%, endocardial <19% and epicardial <15% layer strain predicted combined endpoints but did not significantly improve the prognostic power of tested models, based on NT-proBNP and EF in follow-up.