Organization of postural equilibrium in several planes in ballet dancers.

This study analyzed the balance strategies of ballet dancers during postural equilibrium in three single leg balance conditions with and without vision and regard to age. Dancers participating formed two groups of 20 dancers each, one aged between 8 and 16 years (young group) and the other aged between 17 and 30 years (adult group). Ground reaction forces (GRFs) (mediolateral (ML), anteroposterior (AP) components, vertical (V)) were recorded. Results analysis enabled us to extract some spatiotemporal data for each component of the GRF (number of GRF oscillations, variability and impulses). Young dancers are characterized, compared to adult dancers, by an instability combined with an increase of oscillations number and a decrease variability mainly visible on the ML component. In the two groups, the absence of vision implies an increase of AP, ML and V impulsions and GRF variability. Balance with the gesturing limb to the rear increases the age and vision effect compared to balances with the limb forward or to the side. Young dancers are less efficient at controlling their balance than adult dancers. This observation may be related to the number of hours practicing dance, which differs between groups. The dancers have a visual dependence to control the postural balance.

Native valve endocarditis due to Candida glabrata treated without valvular replacement: a potential role for caspofungin in the induction and maintenance treatment.

Conventional antifungal therapy for fungal endocarditis has been associated with a poor cure rate. Therefore, combined medical and surgical therapy has been recommended. However, new potent antifungal agents, such as echinocandins, could increase the medical options and, in some cases, avoid the need for surgery. We report a case of Candida endocarditis treated successfully without valve replacement with intravenous liposomal amphotericin B (total dose, 4 g) and intravenous caspofungin (a 100-mg loading dose followed by 50 mg per day for 8 weeks) as induction therapy and intravenous caspofungin (100 mg 3 times per week for 12 weeks) as maintenance therapy.

Hepatopulmonary syndrome in candidates for liver transplantation.

BACKGROUND: Hepatopulmonary syndrome (HPS) has been defined as a clinical triad, including chronic liver disease, gas exchange defects (increased alveolar-arterial PO2 difference irrespective of the presence of arterial hypoxemia), and widespread intrapulmonary vascular dilatations. We determined the incidence and the clinical and pulmonary functional characteristics of HPS in candidates for orthotopic liver transplantation (OLT) and tested their predicted accuracy. METHODS: We studied 80 patients with cirrhosis prospectively, and carried out contrast-enhanced (CE) echocardiography and lung function tests, including ventilation-perfusion (V(A)/Q) distributions. RESULTS: Fourteen patients had HPS (incidence, 17.5%). Patients with HPS (49 +/- 12 (+/-SD) years) had more cutaneous spiders, finger clubbing and dyspnea (P < 0.05 each) and a lower diffusing capacity (DLCO, 56 +/- 18% predicted; P < 0.001) than non-HPS patients (n = 66). Mild to moderate V(A)/Q inequalities and increased intrapulmonary shunt were predominant in HPS patients, but oxygen diffusion impairment was observed in those with hypoxemia (n = 8) only. The DLCO showed a considerable area under the receiver operating characteristic curve (0.89). CONCLUSIONS: HPS in cirrhotic patient candidates for OLT shows a high incidence and these patients present with distinctive clinical and functional features compared with non-HPS individuals. The presence of a low DLCO may be of help for the diagnosis of HPS.

Malignant hypertrophic cardiomyopathy caused by the Arg723Gly mutation in beta-myosin heavy chain gene.

Mutations causing hypertrophic cardiomyopathy have been described in nine genes encoding sarcomeric proteins. We report a new mutation in three families, with a C-->G transversion in nucleotide 12 307 of the beta-myosin heavy chain gene, located at the essential light chain interacting region, resulting in the replacement of arginine by glycine at amino acid residue 723. PCR amplification of the selected regions followed by single strand conformation polymorphism analysis, DNA sequencing of the polymorphic patterns and restriction analysis were used to detect the mutation. A total of 23 individuals were diagnosed as carriers, and seven were obligate carriers or had been clinically diagnosed. The Arg723Gly mutation was associated with a malignant phenotype. Ten out of 30 affected members died suddenly or needed an implantable cardioverter-defibrillator at a mean age of 42, and seven members developed progressive heart failure, leading to death or heart transplant in five, at a mean age of 50 years. Echocardiography showed non-obstructive left ventricular hypertrophy in affected members older than 20 (sensitivity 68%). Mean survival of affected members was 51 years. In conclusion, a new mutation Arg723Gly in beta-myosin heavy chain gene is reported which shortens life expectancy because of sudden death and end-stage heart failure.

Beta-adrenergic receptor density and function in left ventricular hypertrophy in young essential hypertensives.

A sympathetic overactivity has been reported in the early stages of essential hypertension and has been involved in the pathogenesis of left ventricular hypertrophy (LVH) in essential hypertension. The state of beta2-adrenergic receptors as related to the presence of this complication was investigated in a group of 15 essential hypertensive patients and compared to 10 normotensive control subjects. Left ventricular mass index was determined by bidimensional echocardiography. Plasma catecholamine levels were measured by a radioenzymatic assay. beta2-adrenoceptor density was measured in intact lymphocytes by radioligand binding assay, using the hydrophilic ligand CGP 12177. beta2- adrenoceptor function was assessed by measuring intracellular cAMP levels in isoproterenol-stimulated lymphocytes. Left ventricular mass index (P < 0.05), body mass index (P < 0.01), plasma noradrenaline levels (P < 0.05) and beta2-adrenoceptor density (P < 0.05) were higher in hypertensives than in controls. Left ventricular mass index correlated with body mass index both in normotensives and hypertensives, as well as with plasma noradrenaline levels only in normotensives. Left ventricular mass index also showed a positive correlation with mean arterial pressure and an inverse relationship with beta2-adrenoceptor density and response only in hypertensive patients. In conclusion, left ventricular hypertrophy in young essential hypertensives is associated to a reduced beta2-adrenoceptor density and function, probably as a compensating mechanism of the hypertrophied myocardiocyte secondary to the increased sympathetic outflow. Journal of Human Hypertension (2000) 14, 17-21.

Lack of association between ACE gene polymorphism and left ventricular hypertrophy in essential hypertension.

The possible association between the insertion/deletion (I/D) polymorphism of the angiotensin I converting enzyme (ACE) gene and left ventricular hypertrophy (LVH) was investigated in a group of essential hypertensive patients. Seventy-one essential hypertensive patients (35 men and 36 women), aged 51 +/- 1 years, were genotyped by PCR for the I/D polymorphism of the ACE gene. Cardiac morphology and function were assessed by means of M-mode echocardiography. The relative frequencies of the three genotypes, DD, DI, and II, were respectively: 24%, 55%, and 21%. Mean values of left ventricular mass index were 145, 144, and 150 g/m2 for DD, DI, and II genotypes, without significant differences among them (P = 0.82). Likewise, the prevalence of LVH (76%, 64%, and 87%) was not significantly different among the three genotypes (P = 0.23). We conclude that the ACE gene I/D polymorphism is not associated with LVH in essential hypertension. Journal of Human Hypertension (2000) 14, 47-49.

G-Protein beta(3) subunit gene variant and left ventricular hypertrophy in essential hypertension.

A functional genetic variant consisting of a C825T substitution in the GNB3 gene, encoding for the G-protein beta(3) subunit, has been associated with enhanced G-protein activation and cell growth. The aim of the study was to investigate the association of this polymorphism with left ventricular hypertrophy (LVH) in a sample of patients with essential hypertension. Left ventricular mass was assessed by 2-mode echocardiography in 86 patients with essential hypertension, and GNB3 C825T genotype was determined by polymerase chain reaction and restriction digestion. Thirty-seven (0.43) patients were homozygous for the C allele (CC), 40 (0.47) were heterozygous (CT), and 9 (0.10) were homozygous for the T allele (TT). The genotype distribution among the patients was in Hardy-Weinberg equilibrium. Values of left ventricular end-diastolic diameter (52.0+/-0.7 versus 48.9+/-0.9 mm, P=0.007), posterior wall thickness (11.3+/-0.2 versus 10.6+/-0.2 mm, P=0.042), and left ventricular mass index (152.7+/-4.4 versus 135.2+/-6.4 g/m(2), P=0. 023) were significantly higher in patients with CT and TT genotypes considered together (CT+TT) than in CC patients. The distribution of the genotypes was significantly different when comparing patients with LVH: 20 (0.33) CC and 40 (0.67) CT+TT patients had this complication, and 17 (0.65) CC and 9 (0.35) CT+TT patients did not (P<0.01). The frequency of the T allele was significantly different among patients with (0.40) and without (0.20) LVH (P<0.01). A logistic regression analysis showed that the association between the T allele and LVH was independent of age, mean blood pressure, body mass index, and alcohol consumption. The relative risk of LVH in patients bearing the T allele (CT+TT group) compared with CC hypertensive patients was 3.03 (95% CI 1.14 to 8.05). The findings suggest an association between LVH and the 825T allele in hypertensive patients.

Diastolic function impairment in alcoholics.

BACKGROUND: Chronic excessive ethanol consumption exerts a deleterious effect on the myocardium. Although the effects of chronic alcoholism on systolic cardiac function are well known, diastolic involvement has been evaluated only partially. Therefore, we determined the presence of left ventricular diastolic impairment in chronic alcoholics and its relation with simultaneous systolic dysfunction. We also assessed the influence of ethanol consumption in diastolic impairment. METHODS: Thirty-five alcoholics with cardiomyopathy (ejection fraction < or = 50%) and 77 alcoholics with normal systolic function (ejection fraction > 50%) were evaluated. Assessment of New York Heart Association functional class, history of ethanol intake, technetium-99m radionuclide angiocardiography, and bidimensional Doppler echocardiography with evaluation of systolic and diastolic left ventricular function were performed. RESULTS: Diastolic function impairment was present in one third of the alcoholics without cardiomyopathy, compared with two thirds of the patients with cardiomyopathy (p < 0.01). A pseudonormalization phenomenon of diastolic function was observed in patients with more advanced systolic dysfunction (ejection fraction < 32%). The deterioration of the diastolic parameters correlated with ethanol consumption, regardless of age (r = 0.44, p < 0.001 for ratio of peak velocity of the transmitral flow in early diastole and peak velocity of atrial contraction flow, with lifetime dose of ethanol). CONCLUSIONS: There seems to be a dose-dependent effect of ethanol on systolic and diastolic heart function. Diastolic function impairment is present in one third of alcoholics with normal systolic function and is even more frequent when systolic dysfunction coexists.

Six-year experience with cryopreserved mitral homografts in the treatment of tricuspid valve endocarditis in HIV-infected drug addicts.

BACKGROUND AND AIM OF THE STUDY: In the past, valve homografts have been used in the treatment of aortic endocarditis. This report details our experience in tricuspid valve replacement using cryopreserved mitral homografts in HIV-positive drug addicts with infective endocarditis. METHODS: Five HIV-1-infected drug addicts with active uncontrollable tricuspid valve endocarditis underwent tricuspid valve replacement with a cryopreserved mitral homograft. RESULTS: There was no early mortality, and median follow up was 5 years (range: 1 to 6 years). One late mortality occurred as a result of heroin overdose. Three of the five patients developed six episodes of recurrent bacterial tricuspid endocarditis on the homograft; these were cured successfully with antibiotics. All survivors remain in NYHA functional class I. The latest transthoracic echocardiography examination showed mild, moderate or severe regurgitation in one, two and two patients, respectively. To date, neither homograft calcification nor rupture of the papillary muscle has been detected. CONCLUSIONS: This novel technique is considered to be an adequate approach to these cases of uncontrollable infectious disease. Further episodes of valvular infection can be managed medically.

Influence of human immunodeficiency virus 1 infection and degree of immunosuppression in the clinical characteristics and outcome of infective endocarditis in intravenous drug users.

BACKGROUND: Immunosuppression caused by human immunodeficiency virus 1 (HIV) infection appears to modify the clinical characteristics and to increase the severity of several bacterial infections. The impact of HIV infection and the degree of immunosuppression on the clinical characteristics and outcome of infective endocarditis (IE) in intravenous (IV) drug users has not been well characterized. METHODS: Prospective cohort study among 292 consecutive IV drug users with IE diagnosed in 2 academic institutional hospitals in Barcelona, Spain, from January 1, 1984, to October 31, 1995. Serostatus of HIV infection was documented in 283 patients. We measured demographics, clinical and biological data, cause, echocardiographic findings, HIV serostatus and classification, CD4 cell count, complications, and mortality. RESULTS: Among the 283 episodes of IE, 216 (76.3%) were in HIV-infected patients and 67 (23.7%) in non-HIV-infected patients. Rate of IE per 1000 admissions ranged from 0.17 to 0.82 per year, peaking in 1989. Characteristics of IE independently associated with HIV infection were right-side involvement (odds ratio [OR], 7.6; 95% confidence interval [CI], 3.5-16.7), a micro-organism different from viridans streptococci (OR, 2.5; 95% CI, 1.1-5.9), duration of drug abuse longer than 5 years (OR, 5.0; 95% CI, 2.4-10.3), and white blood cell count of no more than 10 X 10(9)/L (OR, 2.2; 95% CI, 1.1-4.2). There were no significant differences in mortality due to IE according to HIV serostatus. Among the 216 patients with HIV infection, the variables independently associated with worse outcome were CD4 cell count lower than 0.200 x 10(9)/L and left-sided or mixed IE. CONCLUSIONS: Although there is a difference in clinical presentation in IE in IV drug users, outcome was similar according to their HIV status. However, among HIV-infected patients, severe immunosuppression and mixed or left-side valvular involvement were strong risk factors for mortality.

[Prognostic value of dipyridamole echocardiography in 1st acute uncomplicated myocardial infarction]. / Valor pronóstico de la ecocardiografía con dipiridamol en el primer infarto agudo de miocardio no complicado.

BACKGROUND: To assess the prognostic value of dipyridamole stress echocardiography in survivors of a first uncomplicated acute myocardial infarction. PATIENTS AND METHODS: A total of 75 patients (68 men, 7 women) aged 58 years (range, 37-77) were studied 3-5 days after a first acute myocardial infarction and followed up for a mean of 10 months. Dipyridamole infusion was administered at high doses: 0.56 mg/kg, adding 0.28 mg/kg if the test was still negative. Two-dimensional echocardiography was continuously recorded during infusion and the test was considered positive if a decrease in regional contractile function appeared and negative if no assynergy was observed up to 15 min after the beginning of dipyridamole administration. A wall motion score index of regional function was derived by summation of individual segment scores divided by the number of interpreted segments. This was calculated for rest and peak dipyridamole echocardiograms. Fifty of 75 patients underwent coronary angiography based on clinical criteria. RESULTS: There were 31 coronary events: 4 deaths, one reinfarction, 13 angina. Thirteen patients underwent coronary revascularization (9 bypass and 4 angioplasty). Dipyridamole echocardiography was positive in 29 patients (39%) and negative in 46 patients (61%). Twenty patients (69%) presented coronary events in the group of positive test versus only 11 (24%) of negatives (p = 0.0001). Four patients died in the positive group while none in the negative group. Sensitivity, specificity and accuracy for all cardiac events were 65, 80 and 73%, respectively. Significant variables from univariate analysis were dipyridamole stress echocardiography response, wall motion score index at peak dipyridamole, ischemic changes in ECG and treatment with two or more antianginal drugs. Multivariate analysis showed positive dipyridamole echocardiography as the only independent prognostic factor to predict cardiac events in postmyocardial infarction patients (RR = 2.56; 95% CI = 1.12-5.84). Four of 19 patients with one vessel disease and 17 of 22 patients with 2-3 vessel disease presented a positive dipyridamole test; whereas the test was negative in the remaining nine patients with normal coronary angiography. CONCLUSION: Dipyridamole stress echocardiography is a safe and feasible pharmacologic stress imaging method to stratify postmyocardial infarction patients at risk of cardiovascular events.

Hypertrophic cardiomyopathy and systemic lupus erythematosus.

We report the case of a 45 year-old woman with systemic lupus erythematosus (SLE), who developed clinical and echocardiographic signs of hypertrophic cardiomyopathy. Neither a family history of cardiomyopathy or sudden death nor a personal history of hypertension or valvular lesions were present. The association of SLE with hypertrophic cardiomyopathy has been previously described in only 2 patients.

Comparison of alcoholic cardiomyopathy in women versus men.

To compare the prevalence and cardiac status of male and female alcoholics with alcoholic cardiomyopathy during a 5-year period, all chronic alcoholics with dilated cardiomyopathy who had clinical symptoms of heart failure were included. Alcoholic cardiomyopathy was diagnosed in 10 chronic alcoholic women and in 26 men; the prevalence of alcoholic cardiomyopathy was similar in both sexes. No significant differences were observed in age, nutritional parameters, and clinical and radiologic data of heart failure between the 2 groups. Alcoholic women reported a significantly lower daily dose of ethanol (p = 0.002), a shorter duration of alcoholism (p = 0.017), and a lower total lifetime dose of ethanol consumption (p = 0.001), and had a lower New York Heart Association functional class than men. Women also had lesser ventricular dysfunction than men. In a multivariate analysis, left ventricular systolic dysfunction was related to the total lifetime dose of ethanol consumption (p <0.04), but not to gender. Finally, when patients were matched for left ventricular ejection fraction, women had consumed a lower total lifetime dose of ethanol than men (p <0.001). The prevalence of alcoholic women with dilated cardiomyopathy was found to be similar to that of alcoholic men, although women required a lower total lifetime dose of ethanol to develop the disease.

Increased left ventricular mass in salt-sensitive hypertensive patients.

Clinical, biochemical and echocardiographic characteristics were evaluated from 50 essential hypertensive patients classified asccording to their salt-sensitivity status. Salt-sensitive hypertension was diagnosed by means of ambulatory blood pressure monitoring (ABPM) in 22 (44%) patients showing a significant increase in mean BP (P < 0.05) from a 7-day period of low salt (20 mmol NaCl/day) intake, to a 7-day period of high salt (260 mmol NaCl/day) intake. The remaining 28 (56%) patients were considered as having salt-resistant hypertension. Compared with salt-resistant patients, salt-sensitive ones showed an increased left ventricular mass index (P = 0.0118), septal (P = 0.0021) and posterior wall thickness (P = 0.0026), without differences in the internal diastolic diameter. Decreased values of HDL-cholesterol (P = 0.0475) and increased total cholesterol/HDL-cholesterol ratio (P = 0.0098) were also observed in the salt-sensitive, compared with the salt-resistant hypertensive patients. Age, gender, body mass index, systolic and diastolic BP, fasting plasma glucose, creatinine and uric acid did not differ between salt-sensitive and salt-resistant patients. We conclude that, at the same level of BP, salt-sensitive patients exhibit an increased prevalence of left ventricular hypertrophy and a worse lipid profile. These two aspects may confer to salt-sensitive patients an increased risk in terms of cardiovascular morbidity and mortality.

The greater risk of alcoholic cardiomyopathy and myopathy in women compared with men.

OBJECTIVE: To compare the cardiac and muscular status of male and female alcoholics to determine if the response of women to alcohol is different from that of men. DESIGN: Cross-section study. SETTING: An ambulatory alcoholism treatment unit in the Hospital Clínic of Barcelona. PATIENTS: Fifty asymptomatic alcoholic women, 100 asymptomatic alcoholic men, and 50 female nonalcoholic controls. MAIN OUTCOME MEASURES: Studies included clinical assessment of muscle strength, muscle biopsy, echocardiography, radionuclide cardiac angiography, and treadmill exercise electrocardiographic recording test. RESULTS: The mean strength of the deltoid muscle in alcoholic women was significantly lower than that in controls (P < .001) and half suffered clinical weakness (muscle strength > or = 2 SD below controls). Muscle biopsy specimens from half of all asymptomatic women showed histologic evidence of myopathy. Left ventricular ejection fractions tended to be depressed, and a third of the alcoholic women had evidence of cardiomyopathy. Muscular strength and ejection fractions in women were inversely correlated with the total lifetime dose of ethanol, whereas the left ventricular mass showed a direct correlation. Of the alcoholic men, 39% suffered clinical weakness, and 45% had histologic evidence of myopathy. Evidence of cardiomyopathy was found in almost a third of the men, and their ejection fractions also correlated inversely with the total lifetime dose of ethanol. However, the threshold dose for the development of cardiomyopathy was considerably less in women than in men, and the decline in the ejection fraction with increasing alcohol dose was significantly steeper (P < .001). CONCLUSIONS: Despite the fact that the mean lifetime dose of alcohol in female alcoholics was only 60% that in male alcoholics, cardiomyopathy and myopathy were as common in female alcoholics as in male alcoholics. This finding, together with a more pronounced response of the ejection fraction to the dose of ethanol, indicates that women are more sensitive than men to the toxic effects of alcohol on striated muscle.

Neurohormonal and hemodynamic changes in severe cases of the ovarian hyperstimulation syndrome.

OBJECTIVE: To evaluate systemic hemodynamics, endogenous vasoactive neurohormonal factors (renin-angiotensin and sympathetic nervous systems, antidiuretic hormone, atrial natriuretic factor, and renal prostaglandins), and renal function in the severe ovarian hyperstimulation syndrome. DESIGN: Prospective longitudinal study. SETTING: Assisted-reproduction unit of a tertiary care hospital in Barcelona, Spain. PATIENTS: 31 consecutive patients having in vitro fertilization with development of ascites because of severe ovarian hyperstimulation syndrome. MEASUREMENTS: Mean arterial pressure; cardiac output; peripheral vascular resistance; hematocrit concentration; renal function; plasma renin activity; plasma aldosterone, norepinephrine, antidiuretic hormone, and atrial natriuretic peptide determinations; and urinary excretion of prostaglandin E2 and 6-keto-prostaglandin-F1 were measured during the syndrome and 4 to 5 weeks after recovery (baseline). RESULTS: During the syndrome, patients showed increased hematocrits (mean of the paired difference, 0.047; 95% CI, 0.029 to 0.064), decreased mean arterial pressure (-16.6 mm Hg; CI, -19.8 to -13.6), increased cardiac output (2.6 L/min; CI, 2.13 to 3.17), and reduced peripheral vascular resistance (-709 dyne/s.cm-5;CI, -792 to -627). This was accompanied by marked increases of plasma renin (14.4 ng/L.s; CI, 9.87 to 18.90), norepinephrine (1.857 nmol/L; CI, 0.533 to 3.161), antidiuretic hormone (3.3 pg/mL; CI, 1.89 to 4.71), and atrial natriuretic peptide levels (9.7 fmol/mL; CI, 6.1 to 13.2). Hemoconcentration developed in 16 patients (mean of the paired difference in hematocrit concentration, 0.082; CI, 0.063 to 0.101) but not in 15 others (0.009; CI, 0.003 to 0.021). Both groups showed similar values for arterial pressure, cardiac output, and peripheral vascular resistance, but patients with hemoconcentration had higher (P < 0.05) levels of renin (mean, 20.97 ng/L.s[CI, 13.3 to 28.63] compared with 7.83 ng/L.s[CI, 4.08 to 11.58]), norepinephrine (3.907 nmol/L [CI, 3.057 to 4.757] compared with 2.417 [CI, 2.035 to 2.799]), and antidiuretic hormone (6.0 pg/mL [CI, 4.1 to 7.9] compared with 2.4 [CI, 1.7 to 3.03]). CONCLUSIONS: In addition to increased capillary permeability, severe ovarian hyperstimulation syndrome is consistently associated with arteriolar vasodilation. The simultaneous occurrence of these disorders leads to hyperdynamic circulatory dysfunction with marked stimulation of the sympathetic nervous system, renin-angiotensin system, and antidiuretic hormone.

Management of persistent tricuspid endocarditis with transplantation of cryopreserved mitral homografts.

Transplantation of the human mitral valve in the tricuspid position for intractable infective endocarditis has been successfully performed in three young patients who were addicted to drugs. The maximum follow-up is 20 months. The rationale and historical basis for using this approach in the surgical treatment of patients with right-sided infective endocarditis is discussed and the appropriate literature reviewed. Because the technical aspects have been previously reported, this article can be considered an argument to renew past interest in atrioventricular valve replacement with fully biologic tissue of human origin.

The relation of alcoholic myopathy to cardiomyopathy.

OBJECTIVE: To evaluate the relation between skeletal muscle disease (myopathy) and degenerative changes in cardiac muscle (cardiomyopathy) in patients with chronic alcoholism. DESIGN: A cross-sectional study. SETTING: University medical center. PARTICIPANTS: Group A included 24 patients with chronic alcoholism who had dilated cardiomyopathy; group B, 24 patients with chronic alcoholism who had normal cardiac function; group C, 12 patients with dilated cardiomyopathy because of coronary heart disease; group D, 12 patients with idiopathic dilated cardiomyopathy; group E, 24 normal participants; and group F, 5 young men who died suddenly in traffic accidents. MEASUREMENTS: Clinical assessment of muscle strength, echocardiography, radionuclide cardiac angiography (groups A to E), muscle biopsy (groups A, B, E), endomyocardial biopsy of the left ventricle (group A), and examination of postmortem specimens of the left ventricle (group F). RESULTS: Alcoholic patients with cardiomyopathy had less muscle strength than did alcoholic patients with normal cardiac function, patients with idiopathic dilated cardiomyopathy, and patients with coronary heart disease (all P < 0.01). Among alcoholic patients with cardiomyopathy, 20 of 24 (83%) had histologic findings of skeletal myopathy compared with 1 of 24 (4%) alcoholic patients with normal cardiac function (P < 0.001). Interstitial fibrosis occurred in all cardiac biopsy specimens, hypertrophy of the myocytes occurred in 95%, and myocytolysis occurred in 83%. Those patients with more severe cellular hypertrophy and interstitial fibrosis of the myocardium had a greater decrease in deltoid muscle strength and had worse histologic myopathy. CONCLUSIONS: Diseases of skeletal and cardiac muscle in patients with chronic alcoholism are clinically and histologically related. The presence of muscle weakness in an alcoholic person suggests the likelihood of an accompanying cardiomyopathic abnormality.