Update on the diagnosis and treatment of alcoholic dilated cardiomyopathy
Keywords:
alcohol; alcoholic dilated cardiomyopathy; diagnosis; heart failure; treatmentAbstract
Introduction: Alcoholic dilated cardiomyopathy is a significant cause of non-ischemic heart failure resulting from chronic and excessive alcohol consumption. Although advances in elucidating its pathophysiological mechanisms are notable, early diagnosis and adequate treatment continue to present challenges in high-risk groups.
Objective: To update recent evidence on the pathophysiology, diagnosis, and treatment of alcoholic dilated cardiomyopathy.
Methods: A bibliographic review (2018-2025) was conducted according to PRISMA guidelines in PubMed, SciELO, and Cochrane. Out of 178 identified records, 27 studies (ESC guidelines, observational/prospective) were selected after title/abstract and full-text evaluation. Quality was assessed using GRADE/Newcastle-Ottawa scales. A narrative synthesis with critical analysis of reported statistical measures was performed.
Development: Alcoholic dilated cardiomyopathy results from direct myocardial damage induced by ethanol and oxidative stress, with nonspecific clinical manifestations. Its diagnosis requires a history of high alcohol consumption, echocardiographic evidence of ventricular dilatation and systolic dysfunction, and the exclusion of other cardiomyopathies. Abstinence is the cornerstone of treatment, complemented by standard pharmacotherapy for heart failure. A multidisciplinary management approach involving cardiology, addiction medicine, and psychosocial support is essential to optimize prognosis.
Conclusions: Alcoholic dilated cardiomyopathy requires a comprehensive approach that combines prevention, timely diagnosis, and standardized pharmacological treatment. Alcohol abstinence is crucial for the reversibility of ventricular dysfunction. The need for public policies to reduce its incidence and promote research into specific therapeutic targets is emphasized.
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