RT Journal Article SR Electronic T1 Moderate excess alcohol consumption and adverse cardiac remodelling in dilated cardiomyopathy JF Heart JO Heart FD BMJ Publishing Group Ltd and British Cardiovascular Society SP heartjnl-2021-319418 DO 10.1136/heartjnl-2021-319418 A1 Upasana Tayal A1 John Gregson A1 Rachel Buchan A1 Nicola Whiffin A1 Brian P Halliday A1 Amrit Lota A1 Angharad M Roberts A1 A John Baksi A1 Inga Voges A1 Julian W E Jarman A1 Resham Baruah A1 Michael Frenneaux A1 John G F Cleland A1 Paul Barton A1 Dudley J Pennell A1 James S Ware A1 Stuart A Cook A1 Sanjay K Prasad YR 2021 UL http://heart.bmj.com/content/early/2021/08/10/heartjnl-2021-319418.abstract AB Objective The effect of moderate excess alcohol consumption is widely debated and has not been well defined in dilated cardiomyopathy (DCM). There is need for a greater evidence base to help advise patients. We sought to evaluate the effect of moderate excess alcohol consumption on cardiovascular structure, function and outcomes in DCM.Methods Prospective longitudinal observational cohort study. Patients with DCM (n=604) were evaluated for a history of moderate excess alcohol consumption (UK government guidelines; >14 units/week for women, >21 units/week for men) at cohort enrolment, had cardiovascular magnetic resonance and were followed up for the composite endpoint of cardiovascular death, heart failure and arrhythmic events. Patients meeting criteria for alcoholic cardiomyopathy were not recruited.Results DCM patients with a history of moderate excess alcohol consumption (n=98, 16%) had lower biventricular function and increased chamber dilatation of the left ventricle, right ventricle and left atrium, as well as increased left ventricular hypertrophy compared with patients without moderate alcohol consumption. They were more likely to be male (alcohol excess group: n=92, 94% vs n=306, 61%, p=<0.001). After adjustment for biological sex, moderate excess alcohol was not associated with adverse cardiac structure. There was no difference in midwall myocardial fibrosis between groups. Prior moderate excess alcohol consumption did not affect prognosis (HR 1.29, 95% CI 0.73 to 2.26, p=0.38) during median follow-up of 3.9 years.Conclusion DCM patients with moderate excess alcohol consumption have adverse cardiac structure and function at presentation, but this is largely due to biological sex. Alcohol may contribute to sex-specific phenotypic differences in DCM. These findings help to inform lifestyle discussions for patients with DCM.Data are available on reasonable request. The data and analysis methods that support the findings of this study are available from the corresponding author, (UT) on reasonable request. Data will be shared after review and approval by our Biobank scientific board, and terms of collaboration will be reached together with a signed data access agreement.