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Re: Left Ventricular Strain and Rotation by 2-D Speckle Tracking Echocardiography Identify Early Alcoholic Cardiomyopathy
ARTICLE IN PRESS Ultrasound in Med. & Biol., Vol. ■■, No. ■■, pp. ■■–■■, 2017 Copyright © 2017 World Federation for Ultrasound in Medicine & Biology. All rights reserved. Printed in the USA. All rights reserved 0301-5629/$ - see front matter
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Letter to the Editor RE: LEFT VENTRICULAR STRAIN AND ROTATION BY 2-D SPECKLE TRACKING ECHOCARDIOGRAPHY IDENTIFY EARLY ALCOHOLIC CARDIOMYOPATHY
We read with great interest the article by Wang et al. (2016) recently published in Ultrasound in Medicine & Biology. In this article, the authors classified alcohol drinkers based on the duration and level of alcohol consumption. The mild group had consumed >90 mg ethanol 3–5 d/wk for 5–8 y; the moderate group had consumed >90 to 140 mg ethanol 3–5 d/wk for 9–20 y; and the severe group had consumed >150 mg ethanol 6–7 d/wk for >10 y. Although the mild and moderate groups were asymptomatic and had preserved left ventricular ejection fraction (LVEF) and no clinical evidence of heart failure, the severe group included symptomatic patients with decreased LVEF and/or clinical heart failure signs. As a result, one of the major findings of this study was that global longitudinal strain (G-LS) values were significantly decreased in both the severe and asymptomatic moderate alcoholic groups, but not in the mild group. We have some comments related to left ventricular (LV) strain and “early” alcoholic cardiomyopathy. First, although the authors emphasized that there is a lack of early diagnostic methods to allow the detection of alcoholic cardiomyopathy at the asymptomatic stage, we previously published the results of a study that evaluated the impact of alcohol on functional abnormalities of longitudinal systolic function using 2-D speckle tracking echocardiography (2-D-STE) in chronic asymptomatic alcoholic patients (Kalayci et al. 2016). To the best of our knowledge, this was the first study to detect subclinical LV dysfunction in this specific group of patients using the 2-D-STE method. We included 75 patients, all of whom had preserved EF (>50%). After meticulous investigation, we classified alcoholic patients into two groups (group 1: < 15 kg ethanol/kg weight, and group 2: ≥ 15 kg ethanol/kg weight) according to the total lifetime dose of ethanol (TLDE). TLDE is expressed in kilograms of ethanol per kilogram of weight and is estimated by first multiplying the daily consumption of ethanol by the number of days of exposure to alcohol and then dividing the product by the weight of the patient when first admitted (Kocabay et al. 2015; Vittadini et al. 2001). Because TLDE involves the amount consumed daily and the duration of alcohol consumption, we believe that this classification is more appropriate than either the dose- or duration-based criteria. Similar to LVEF results, there were no differences in LV dimensions and LV mass index among alcoholic groups. Contrary to Wang et al. (2016), we found that G-LS was significantly lower in alcoholic patients compared with normal healthy controls, as well as among the alcoholic groups (for G-LS; healthy controls, −19.9 ± 2.7% vs. group 1: −18.3 ± 1.6%, p = 0.005; group 1, −18.3 ± 1.6% vs. group 2: −17.0 ± 1.5%, p = 0.01; and healthy controls vs. group 2: p = 0.001). Furthermore, there was a significant correlation between TLDE and G-LS. Similarly, Wang et al. (2016)
found that for the conventional echocardiographic data (LV diastolic and systolic diameters, interventricular diastolic thickness), there were no significant differences among asymptomatic alcoholic patients and healthy controls. However, G-LS values of the mild and healthy groups were also comparable. Thus, according to their study, 2-D-STE has been found to detect lower strain values only in the asymptomatic “moderate” alcoholic group. However, there is an explicit difference between the mild and moderate groups with respect to duration and daily consumption. If the authors had used the TLDE calculation, the result of the study would have been different. In conclusion, contrary to the Wang et al article, we found that the novel method, 2-D-STE, allowed us to detect “real” early LV systolic dysfunction in chronic alcoholic patients. These impaired functional mechanics parallel the increase in alcohol consumption.
Arzu Kalayci Gonenc Kocabay* Can Karabay Clinic of Cardiology Kartal Kosuyolu Training and Research Hospital Istanbul, Turkey *Address correspondence to: Gonenc Kocabay Clinic of Cardiology Kartal Kosuyolu Training and Research Hospital Istanbul, Turkey. E-mail: [email protected]
REFERENCES Kalayci A, Karabay CY, Kocabay G, Oduncu V, Akgun T, Bakkal RB, Guler A, Erkol A, Izgi A, Kırma C. Subclinical left ventricular dysfunction in chronic asymptomatic alcoholic patients. Kosuyolu Heart J 2016;19:154–160. Kocabay G, Karabay CY, Kalaycı A, Oduncu V, Akgun T, Guler A, Kılıcgedik A, Kalkan S, ˙Izgi A, Kırma C. Left atrial function by speckle-tracking echocardiography in chronic asymptomatic alcoholic patients. Cardiovasc Toxicol 2015;15:189–196. Vittadini G, Buonocore M, Colli G, Terzi M, Fonte R, Biscaldi G. Alcoholic polyneuropathy: A clinical and epidemiological study. Alcohol Alcohol 2001;36:393–400. Wang Y, Li G, Sun Y, Shan G, Xu R, Guo L. Left ventricular strain and rotation by 2-D Speckle tracking echocardiography ıdentify early alcoholic cardiomyopathy. Ultrasound Med Biol 2016;42:1741–1749.
https://doi.org/10.1016/j.ultrasmedbio.2017.07.021
1
●
Letter to the Editor RE: LEFT VENTRICULAR STRAIN AND ROTATION BY 2-D SPECKLE TRACKING ECHOCARDIOGRAPHY IDENTIFY EARLY ALCOHOLIC CARDIOMYOPATHY
We read with great interest the article by Wang et al. (2016) recently published in Ultrasound in Medicine & Biology. In this article, the authors classified alcohol drinkers based on the duration and level of alcohol consumption. The mild group had consumed >90 mg ethanol 3–5 d/wk for 5–8 y; the moderate group had consumed >90 to 140 mg ethanol 3–5 d/wk for 9–20 y; and the severe group had consumed >150 mg ethanol 6–7 d/wk for >10 y. Although the mild and moderate groups were asymptomatic and had preserved left ventricular ejection fraction (LVEF) and no clinical evidence of heart failure, the severe group included symptomatic patients with decreased LVEF and/or clinical heart failure signs. As a result, one of the major findings of this study was that global longitudinal strain (G-LS) values were significantly decreased in both the severe and asymptomatic moderate alcoholic groups, but not in the mild group. We have some comments related to left ventricular (LV) strain and “early” alcoholic cardiomyopathy. First, although the authors emphasized that there is a lack of early diagnostic methods to allow the detection of alcoholic cardiomyopathy at the asymptomatic stage, we previously published the results of a study that evaluated the impact of alcohol on functional abnormalities of longitudinal systolic function using 2-D speckle tracking echocardiography (2-D-STE) in chronic asymptomatic alcoholic patients (Kalayci et al. 2016). To the best of our knowledge, this was the first study to detect subclinical LV dysfunction in this specific group of patients using the 2-D-STE method. We included 75 patients, all of whom had preserved EF (>50%). After meticulous investigation, we classified alcoholic patients into two groups (group 1: < 15 kg ethanol/kg weight, and group 2: ≥ 15 kg ethanol/kg weight) according to the total lifetime dose of ethanol (TLDE). TLDE is expressed in kilograms of ethanol per kilogram of weight and is estimated by first multiplying the daily consumption of ethanol by the number of days of exposure to alcohol and then dividing the product by the weight of the patient when first admitted (Kocabay et al. 2015; Vittadini et al. 2001). Because TLDE involves the amount consumed daily and the duration of alcohol consumption, we believe that this classification is more appropriate than either the dose- or duration-based criteria. Similar to LVEF results, there were no differences in LV dimensions and LV mass index among alcoholic groups. Contrary to Wang et al. (2016), we found that G-LS was significantly lower in alcoholic patients compared with normal healthy controls, as well as among the alcoholic groups (for G-LS; healthy controls, −19.9 ± 2.7% vs. group 1: −18.3 ± 1.6%, p = 0.005; group 1, −18.3 ± 1.6% vs. group 2: −17.0 ± 1.5%, p = 0.01; and healthy controls vs. group 2: p = 0.001). Furthermore, there was a significant correlation between TLDE and G-LS. Similarly, Wang et al. (2016)
found that for the conventional echocardiographic data (LV diastolic and systolic diameters, interventricular diastolic thickness), there were no significant differences among asymptomatic alcoholic patients and healthy controls. However, G-LS values of the mild and healthy groups were also comparable. Thus, according to their study, 2-D-STE has been found to detect lower strain values only in the asymptomatic “moderate” alcoholic group. However, there is an explicit difference between the mild and moderate groups with respect to duration and daily consumption. If the authors had used the TLDE calculation, the result of the study would have been different. In conclusion, contrary to the Wang et al article, we found that the novel method, 2-D-STE, allowed us to detect “real” early LV systolic dysfunction in chronic alcoholic patients. These impaired functional mechanics parallel the increase in alcohol consumption.
Arzu Kalayci Gonenc Kocabay* Can Karabay Clinic of Cardiology Kartal Kosuyolu Training and Research Hospital Istanbul, Turkey *Address correspondence to: Gonenc Kocabay Clinic of Cardiology Kartal Kosuyolu Training and Research Hospital Istanbul, Turkey. E-mail: [email protected]
REFERENCES Kalayci A, Karabay CY, Kocabay G, Oduncu V, Akgun T, Bakkal RB, Guler A, Erkol A, Izgi A, Kırma C. Subclinical left ventricular dysfunction in chronic asymptomatic alcoholic patients. Kosuyolu Heart J 2016;19:154–160. Kocabay G, Karabay CY, Kalaycı A, Oduncu V, Akgun T, Guler A, Kılıcgedik A, Kalkan S, ˙Izgi A, Kırma C. Left atrial function by speckle-tracking echocardiography in chronic asymptomatic alcoholic patients. Cardiovasc Toxicol 2015;15:189–196. Vittadini G, Buonocore M, Colli G, Terzi M, Fonte R, Biscaldi G. Alcoholic polyneuropathy: A clinical and epidemiological study. Alcohol Alcohol 2001;36:393–400. Wang Y, Li G, Sun Y, Shan G, Xu R, Guo L. Left ventricular strain and rotation by 2-D Speckle tracking echocardiography ıdentify early alcoholic cardiomyopathy. Ultrasound Med Biol 2016;42:1741–1749.
https://doi.org/10.1016/j.ultrasmedbio.2017.07.021
1