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Between 1994-1998, we retrospectively studied a cohort of 396 consecutive patients with dilated cardiomyopathy, mean age 53 +/- 15 years, 74% men. The history of alcohol intake was abstracted from the medical records. During a follow-up period of 42 +/- 26 months, 83 (76% men) patients died and 15 (80% men) underwent cardiac transplantation. Men were younger and more likely to have a history of excessive alcohol intake compared with women. Gender significantly modified the risk of alcohol consumption on mortality. Although alcohol intake increased the mortality risk in women, it was protective toward death in men (hazards ratios for death were 7.3 vs. 0.44). The effect of alcohol intake on outcome was reassessed after classifying the patients into 4 groups: group 1: life-long nondrinkers; group 2: former drinkers; group 3: moderate drinkers; and group 4: heavy drinkers. Similar findings were seen. This study demonstrated that the risk of reported alcohol intake on mortality is related to gender in patients with nonischemic heart failure. Our findings deserve further study, including a larger number of females, as a possible way to improve outcome in such patients.

Objective-To compare resting long axis echocardiography with adenosine thallium-201 emission tomography in detecting myocardial ischaemic abnormalities in patients before peripheral vascular surgery. Design-A prospective and blinded preoperative examination of resting left ventricular minor and long axes and myocardial perfusion during adenosine vasodilatation using thallium-201 emission tomography. Setting-A tertiary referral centre for cardiac and vascular disease equipped with invasive, non-invasive, and surgical facilities. Subjects-65 patients (40 men) with significant peripheral vascular disease, mean (SD) age 63 (10) years, and 21 control subjects of similar age. Methods-Segments were classified as normal, with fixed or reversible defects according to thallium-201 myocardial perfusion tomography. Systolic long axis abnormalities were either reduced excursion and/or abnormal shortening after A2, and diastolic abnormalities either delayed onset of lengthening > 80 ms and/or reduced peak lengthening rate < 4.5 cm/s. Segmental perfusion defects were compared with the equivalent long axes; anteroseptal for septal, inferoseptal for posterior, and lateral for left side giving a total of 195 segments. Results-Systolic long axis abnormalities predicted fixed thallium defects (sensitivity 86%, specificity 87%, positive predictive value 0.78, negative predictive value 0.93, p < 0.001), and diastolic abnormalities correlated with reversible perfusion defects (sensitivity 90%, specificity 85%, positive predictive value 0.72, negative predictive value 0.95, p < 0.001). Echocardiography characteristics of the true and false positive segments were not diVerent in the site or the extent of abnormalities. Conclusion-Systolic long axis abnormalities predict fixed and diastolic reversible thallium perfusion defects in patients with peripheral vascular disease. Ventricular long axis may thus have a value as a screening test before peripheral vascular surgery as well as providing a means of monitoring myocardial perfusion. The high negative predictive values indicate that a negative long axis study makes significant perfusion abnormalities very unlikely in patients with high pretest probability of coronary artery disease. (Heart 1998;79:295-300)

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