Clinical profile and prognostic factors of alcoholic cardiomyopathy in tribal and non-tribal population PMC

This study included not only DCM, but also all causes of left ventricular dysfunction, including hypertensive heart disease, ischemic cardiomyopathy and heart valve disease. Furthermore, the inclusion criteria for ACM were very strict and required a minimum consumption of 8 oz of alcohol (200 g or 20 standard units) each day for over 6 mo. In contrast, European studies focusing on the prevalence of ACM included only subjects diagnosed with DCM and alcoholic cardiomyopathy applied the consumption threshold of 80 g/d for ≥ 5 years, finding an ACM prevalence of 23%-47% among idiopathic DCM patients9-12 (Figure 1). Despite the key clinical importance of alcohol as a cause of DCM, relatively few studies have investigated the effects of alcohol on the heart and the clinical characteristics of DCM caused by excessive alcohol consumption (known as alcoholic cardiomyopathy).

Statistical analysis

Additionally, echocardiographic data suggest that subjects who do not fully withdraw from alcohol consumption, but who reduce it to moderate amounts recover LVEF in a similar manner to strict non-drinkers. Thus, Nicolás et al73 studied the evolution of the ejection fraction in 55 patients with ACM according to their degree of withdrawal. The population was divided into 3 groups according to their intake volume during the follow-up period. At the end of the first year, no differences were found among the non-drinkers, who improved by 13.1%, and among those who reduced consumption to g/d (with an average improvement of 12.2%).

LIMITATIONS OF ACM STUDIES

From January 2013 to December 2016, we collected data of 290 patients with ACM referred for evaluation to the Department of Internal Medicine and Department of Cardiology in our institute RIMS, Ranchi. This study was a retrospective, observational study and a diagnosis of ACM was made in accordance to the definition provided in the European Society of Cardiology consensus document on the classification of cardiomyopathies. As pointed out before, the current accepted definition of ACM probably underestimates the number of women affected by the disease. Alcohol affects heart function and is dependent on the quantity of alcohol that the heart is exposed to. Women typically have a lower BMI than men, and therefore the same alcohol exposure can be achieved with lower alcohol intake.

Data availability

Xiong et al.105 reported the highest accuracy for MI localization using ResNet106, achieving 99.99% accuracy, followed by 99.95% using a convolutional neural network. Advances DL approaches have demonstrated exceptional performance in ECG classification, addressing challenges such as overfitting and the need for hand-crafted features. Stacked autoencoders, comprising multiple layers of autoencoders and a classifier, learn robust representations through complex relationships102. For ECG classification, denoising and sparse autoencoders can enhance feature detection102. Finally, it should be noted that McKenna and co-workers, in one of the most frequently cited papers in the ACM field, reported an incidence of 40% in 100 individuals suffering from idiopathic DCM, but in this case the consumption threshold used was only g/d8.

• In light of the available data, new studies will help to clarify the current prognosis of ACM compared to DCM and to determine prognostic factors in ACM that might differ from known prognostic factors in DCM.
• Traditional risk assessment tools often underestimate the cardiovascular risk in South Asians due to a lack of phenotypic representation in their development.
• In summary, we propose developing a novel risk score specifically designed to predict the risk of MI among South Asians82.
• In recent years, basic and clinical research has shed light on its pathogenesis, which includes direct toxic effects of alcohol on the myocardium, oxidative stress, mitochondrial dysfunction, and genetic susceptibility.

The majority of the echocardiographic studies performed on asymptomatic alcoholics found only mild changes in their hearts with no clear impairment of the systolic function. For example, a slight increase in the pre-ejection period/left ventricular ejection time ratio (PEP/LVET) was found by some authors, suggesting a sub-clinical impairment of systolic function21,33. Mathews and Kino found a small, but significant increase in left ventricular mass in individuals consuming at least 12 oz of whisky during 6 years and 60 g of ethanol per day, respectively22,40. Finally, only Urbano-Márquez et al24 found a clear decrease in the ejection fraction, in a cohort of 52 alcoholics, which was directly proportional to the accumulated alcohol intake throughout the patients’ lives. Studies that have assessed the prevalence of ACM among IDCM patients have found high alcohol consumption in 3.8% to 47% of DCM patients. The lowest prevalence of ACM among DCM (3.8%) was obtained from a series of 673 patients admitted to hospital consecutively due to HF in the state of Maryland27.

Cohort studies in drug addiction treatment rural South India identify tobacco use, alcohol consumption, hypertension, diabetes mellitus, and obesity as significant risk factors9,20. Low physical activity, reduced muscle mass, and central accumulation of ectopic fat also correlate with elevated risk in South Asians. While primary prevention measures, such as exercise and dietary changes, have been effective in the United States, they are underutilized in India, where evidence-based treatments are alarmingly low17,24.

Genome-wide association studies (GWAS) facilitated by next-generation sequencing have identified genetic loci and polymorphisms linked to common CVD risk factors33,34,37,38,46. Although the exact mechanisms driving CVD risk in South Asians are not fully understood, population-specific genetic polymorphisms are believed to play a significant role35,36,37. South Asians demonstrate a higher prevalence of prediabetes and diabetes mellitus, which are significant cardiovascular risk factors. The combination https://ecosoberhouse.com/article/how-long-does-weed-marijuana-stay-in-your-system/ of these genetic traits substantially increases the incidence of CVD in this population16. Comprehensive genetic research is crucial to developing targeted prevention and treatment strategies for CVD in South Asians. The heritability of CVD risk factors is well documented among close relatives, but recent studies have focused on the genetic contribution to population-level CVD risk31,32,33,34,35,36,37,38.

Leveraging ML for improved MI diagnosis in South Asian populations

In another study on this topic, Lazarević et al23 divided a cohort of 89 asymptomatic individuals whose consumption exceeded 80 g/d (8 standard units) into 3 groups according to the duration of their alcohol abuse. Subjects with a shorter period of alcohol abuse, from 5 to 10 years, had a significant increase in left ventricular diameter and volume compared to the control group. Daily consumption of low to moderate amounts of alcohol has beneficial effects on cardiovascular health among both ischemic and non-ischemic patients1-3. In contrast, chronic and excessive alcohol consumption could lead to progressive cardiac dysfunction and heart failure (HF)3. This study included 321 patients with ACM admitted to our hospital between 2003 and 2013.

Association of malnutrition with renal dysfunction and clinical outcome in patients with heart failure

Cell nuclei were larger than normal, morphologically difficult to define and they occasionally showed hyperpigmentation. The authors highlighted the presence of an extensive intracellular accumulation of neutral lipids, principally in the form of small cytoplasmic droplets. In a subsequent study using electron microscopy, the authors found histological features that could be superimposed onto those found in hearts that had suffered hypoxia, anoxia or ischemia43. Analogous to the sarcoplasmic reticulum, the mitochondria were swollen or oedema was present, with crest alterations and intra-mitochondrial inclusions suggesting degenerative processes (Figure 2).

Advanced DL techniques for ECG classification

Given the limitations of existing risk assessment tools for South Asians, clinicians often rely on other methods and parameters. The Mediators of Atherosclerosis in South Asians Living in America (MASALA) study found the coronary artery calcium score to be a very specific marker for subclinical atherosclerosis14. Additionally, the INTERHEART study found the ApoB/ApoA-1 ratio to be a reliable biomarker for predicting CVD risk15.