Effect of AST/ALT Ratio on Prognosis of Alcohol Induced Cardiomyopathy in Chronic Alcoholic Patients: A Cross Sectional Study in a Tertiary Care Centre

Abstract

Background: Alcohol-induced cardiomyopathy (ACM) is an acquired form of dilated cardiomyopathy resulting from prolonged heavy alcohol consumption. Chronic ethanol exposure produces myocardial oxidative stress, mitochondrial dysfunction, myocyte injury, ventricular remodeling and progressive systolic dysfunction. The aspartate aminotransferase/alanine aminotransferase (AST/ALT) ratio, also known as the De Ritis ratio, is traditionally used as a marker of hepatocellular injury but may also reflect systemic tissue injury and impaired cardiovascular function. Evidence regarding its relationship with severity of alcohol-induced cardiomyopathy remains limited. Materials and Methods: A cross-sectional observational study was conducted in the Department of Medicine at a tertiary care hospital. One hundred adult patients with chronic heavy alcohol consumption and echocardiographically documented alcohol-induced cardiomyopathy were included. Serum AST and ALT were measured and the AST/ALT ratio was calculated. Patients were categorized into two groups according to an AST/ALT ratio <1 or ≥1. Echocardiography was performed to assess left ventricular ejection fraction (LVEF), LV dimensions and associated structural abnormalities. For this cross-sectional analysis, poorer cardiac prognosis was operationalized by severe systolic dysfunction and advanced NYHA functional class. Results:Of the 100 patients, 35 had an AST/ALT ratio <1 and 65 had a ratio ≥1. Patients with a ratio ≥1 demonstrated lower mean LVEF than those with a ratio <1 (34.7 ± 7.8% vs. 43.8 ± 8.6%, p<0.001) and had a greater frequency of NYHA class III–IV symptoms (49.2% vs. 14.3%, p<0.001). Advanced ventricular dilation, atrial enlargement and clinically significant arrhythmias were also more frequent in the higher-ratio group. The AST/ALT ratio demonstrated an inverse correlation with LVEF (r=-0.52, p<0.001). On multivariable analysis, AST/ALT ratio ≥1 was independently associated with severe cardiac dysfunction after adjustment for age, duration of alcohol exposure, hypertension and serum albumin.Conclusion: An elevated AST/ALT ratio was associated with poorer cardiac functional status, reduced LVEF and advanced NYHA class among chronic alcoholic patients with alcohol-induced cardiomyopathy. The ratio is inexpensive and routinely available and may serve as an adjunctive marker for identifying patients requiring more intensive cardiovascular assessment. Prospective longitudinal studies are required to determine whether it independently predicts hospitalization or mortality.

Keywords: Alcohol-induced cardiomyopathy, alcoholcardiomyopathy, AST/ALT ratio, De Ritis ratio, left ventricular ejection fraction, heart failure, chronic alcoholism, prognosis.