The recognition of
alcoholic cardiomyopathy in patients with
dilated cardiomyopathy is essential as they may regress, at least partially in a relatively short period, with abstention. The clinical history is the key to diagnosis because no other specific feature can identify the cause. Between January 1984 and July 1995, 26 candidates for
cardiac transplantation with
dilated cardiomyopathy and chronic
alcoholism improved after withdrawal of alcohol. None of these patients was placed on the surgical waiting list. Patients with ischaemic
cardiomyopathy, valvular disease or previous surgery for valvular hypertensive or
congenital heart disease, documented viral
myocarditis or
connective tissue diseases, were excluded. The diagnostic criterion of chronic
alcoholism was a total alcohol consumption of 292 kg and a duration of
alcohol abuse of over 10 years. In addition to the clinical features,
biological, electrocardiographic, echocardiographic and haemodynamic parameters were analysed. The mean age of the patients was 48 +/- 8 years. There were 25 men and 1 woman. The total mean alcohol consumption was 1,492 kg. The average follow-up period was 63 +/- 41 months. The interval between the onset of symptoms and abstention was 25 months. Haemodynamic improvement was observed in 25 cases. The average interval between alcoholic abstention and recovery was 11.7 months. One patient died suddenly. Improvement of symptoms, decrease of the cardiothoracic ratio and improvement of echocardiographic parameters were statistically significant. The increase in angiographic or isotopic ejection fraction and cardiac index and the decrease in mean pulmonary artery pressures were also statistically significant. These results confirmed the diagnosis of
alcoholic cardiomyopathy. Therefore, patients with chronic
alcohol abuse and
dilated cardiomyopathy must be identified and treated for this problem and not placed on the waiting list for
cardiac transplantation unless no improvement is observed after about 3 months of abstention.