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Alcohol DCM Recovery with Abstinence — EECC MCQ

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EasyCardiomyopathyAlcohol DCM Recovery with AbstinenceEECC

A 50-year-old man with alcohol-related DCM (LVEF 20%, drinking >80 g ethanol/day for 15 years) asks about prognosis if he stops drinking. What is the expected trajectory?

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Correct answer: DComplete alcohol abstinence can lead to significant LVEF recovery (improvement of 10-15% or even normalisation) in ~40-50% of patients — making it one of the most important modifiable causes of DCM; partial recovery is common even with reduced (not complete) abstinence

Alcoholic cardiomyopathy is one of the most potentially reversible forms of DCM. With sustained alcohol abstinence: (1) LVEF improvement of 10-15% (often more) occurs in ~40-50% of patients within 6-12 months; (2) some patients achieve complete normalisation of LVEF; (3) even alcohol reduction (without complete abstinence) can produce partial recovery; (4) predictors of recovery: shorter duration of heavy drinking, less severe baseline LV dysfunction, absence of extensive fibrosis on CMR. The 2023 ESC Cardiomyopathy Guidelines recommend: (1) complete alcohol abstinence (Class I); (2) standard HFrEF GDMT alongside abstinence; (3) serial echocardiographic monitoring to track recovery; (4) addiction support services referral. If LVEF does not recover despite abstinence and GDMT, the diagnosis may need re-evaluation (consider genetic testing for underlying genetic DCM unmasked by alcohol).

Reference: ESC (2023): Cardiomyopathies Guidelines