RESUMO
Cardiovascular death is the main cause of mortality in chronic alcoholics, perhaps due to a pro-arrhythmogenic effect of alcohol associated with infraclinical myocardial lesions. The authors investigated prospectively 41 patients (average age: 49.7 years) who were chronic alcoholics but had no acute alcoholic episodes for cardiac disease (ECG, signal averaging for late ventricular potentials, echocardiography and Holter ECG monitoring) and hepatic disease (liver biopsy). The history of alcoholism was 14 +/- 9 years, the quantity of alcohol ingested before they stopped drinking being 89 +/- 31 grammes/day. Thirty per cent of patients displayed 2 or 3 criteria of late ventricular potentials (LP). The authors demonstrated a correlation between the daily quantity of alcohol consumed before stopping drinking and the duration of the filtered QRS complex (p = 0.02). Moreover, the frequency of fatty infiltration found on liver biopsy, greater in alcoholics with LP (35% versus 19%, p = 0.025) correlated with the amplitude of the last 40 ms of the average QRS (p = 0.0485), with the duration of potentials of less than 40 microvolts (p = 0.05) and, above all, with the number of criteria of LP (p = 0.02). Finally, the presence of LP was also related to the following biological abnormalities: GGT (p = 0.027), ASAT (p = 0.046), ALAT (p = 0.039). The ECG abnormalities may reflect early infra-clinical myocardial lesions secondary to cellular metabolic abnormalities perhaps analogous to the fatty hepatic changes. However, the prognostic value of these signal-averaging ECG abnormalities remains unknown.
Assuntos
Alcoolismo/fisiopatologia , Eletrocardiografia , Cardiopatias/etiologia , Adulto , Alcoolismo/complicações , Biópsia , Feminino , Cardiopatias/diagnóstico , Testes de Função Cardíaca , Hepatite Alcoólica/patologia , Humanos , Testes de Função Hepática , Masculino , Pessoa de Meia-Idade , Estudos ProspectivosRESUMO
OBJECTIVE: Cardiac arrest is the most frequent cause of death in chronic alcoholics. Detection of late potentials in this population could be helpful in screening from early signs of myocardial disorders and identifying patients at risk of severe ventricular dysrythmia. PATIENTS AND METHODS: A prospective study of late potentials was conducted in 53 subjects (mean age 49 +/- 10 years) with a history of long-standing alcohol abuse (mean 13.6 +/- 8.5 years, mean daily alcohol intake 86 +/- 30 g). After a period of abstinence, the following explorations were performed: liver tests, liver biopsy, electrocardiogram, echocardiography, Holter recording. RESULTS: Among the 53 patients, 37% were positive for 2 of the 3 criteria for late potentials. There was a strong correlation between the duration of alcohol abuse and presence of late potentials (p = 0.006, r = 0.37). The percentage of hepatic steatosis was higher in alcoholic subjects with late potentials (34% versus 23%; p = 0.05) and was correlated with the number of positive criteria for late potentials (p = 0.05, r = 0.328). Finally, the presence of late potentials was also correlated with the following laboratory results: serum gamma glutamyltranspeptidase (p = 0.031), serum aspartate amino transferase (p = 0.033), serum alkaline phosphatases (p = 0.0025). CONCLUSION: Late potentials can be detected easily although their prognostic value remains to be determined. They could be an early marker of infraclinical myocardial lesions.