Pathomorphology Features of Alcoholic Cardiomyopathy

Pathomorphology Features of Alcoholic Cardiomyopathy | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Pathomorphology Features of Alcoholic Cardiomyopathy Oksana Malyk, Yuliia Kuzyk, Anzhela Lishchynska, Monica Concato This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6623225/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 8 You are reading this latest preprint version Abstract Alcohol is the most well-known toxic substance, and its negative impact on human health and lifestyle is well-documented. Chronic alcoholism is a pathological condition that occurs as a result of excessive alcohol consumption and is most commonly observed in young and middle-aged men. In our study, changes in the left ventricular myocardium due to alcohol consumption were investigated in 70 individuals who died at home under suspicious circumstances and whose bodies were sent to the State Statistical Office "Kyiv City Bureau of Forensic Medical Examination" to determine the cause of death. In 64.3% of cases, a high level of ethyl glucuronide was found in the blood, indicating alcohol consumption within 96 hours prior to death. Heart lesions were represented by dilated cardiomyopathy and myocardial fibrosis. chronic alcohol consumption cardiac changes ethyl glucuronide alcoholic cardiomyopathy Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9 Figure 10 Introduction Sudden death due to cardiovascular diseases is most common in industrialized and urbanized countries and represents a major public health problem. In forensic practice, when examining the bodies of individuals aged 20–60 years who have died suddenly, diagnostic difficulties often arise due to the lack of noticeable pathological changes in the cardiovascular system. One particularly challenging group includes people with a history of long-term alcohol consumption, where an insignificant concentration of ethanol in the blood or urine of the deceased, or its absence, precludes a diagnosis of death due to ethyl alcohol poisoning. Alcohol is one of the most commonly consumed toxic substances worldwide [ 1 ]. While daily low to moderate alcohol consumption has been shown to improve cardiovascular health in patients [ 2 , 3 ], chronic and excessive alcohol consumption can lead to progressive heart failure [ 4 ]. Chronic alcohol consumption or abuse is typically defined as daily consumption of more than 80–90 g of alcohol per day (approximately eight drinks) for a period of at least five years [ 5 , 8 – 10 ]. Alcoholic cardiomyopathy (ACMP) is clinically defined as a form of dilated cardiomyopathy resulting from chronic alcohol abuse and is recognized by the World Health Organization as a distinct clinical entity, assigned the International Classification of Diseases (ICD-10) code I42.6. ACMP accounts for approximately 3.8% of all reported cases of cardiomyopathy and 21–36% of all reported cases of non-ischemic dilated cardiomyopathy [ 6 ]. Clinically and histologically, ACMP is indistinguishable from idiopathic dilated cardiomyopathy. Therefore, a detailed patient history is considered essential for diagnosis [ 11 ]. Women develop ACMP with lower levels of alcohol intake compared to men, although the differences in the amount of alcohol required to develop the disease remain unknown [ 12 ]. Chronic alcohol exposure leads to reduced cardiomyocyte contractility, ventricular dilation, and myocardial fibrosis, which together constitute the morphological substrate for dilated cardiomyopathy [ 7 ]. Due to the absence of specific pathological changes, forensic identification of ACMP can only rely on the patient’s medical history and the exclusion of other causes of cardiomyopathy. This article reviews the forensic identification of ACMP and aims to provide reference material for forensic pathologists and clinicians. The study aims to determine the characteristics of the age-sex distribution and the pathomorphological changes of the heart and vessels in forensic cases of ACMP. Material and methods Seventy cases of ACMP were analyzed at the State Statistical Office "Kyiv City Bureau of Forensic Medical Examination" over three years (2019, 2021, and 2023). Statistical information on the number of fatal cases of ACMP in Ukraine over eight years was processed according to the State Statistics Service of Ukraine ( https://stat.gov.ua/uk/topics/okhorona-zdorovya ). The forensic diagnosis of ACMP was established in deceased individuals who were chronic alcohol consumers, based on the presence of both pathomorphological changes of the heart and vessels, and the determination of ethanol levels in the blood and urine samples. Macroscopically, the following cardiac lesions were detected during autopsy: left ventricular hypertrophy, dilated cardiomyopathy, and endocardial and myocardial fibrosis. Tissues from different parts of the heart (anterior and posterior walls, interventricular septum) and coronary arteries were examined histologically. Standard hematoxylin and eosin staining was used for paraffin sections, along with specific staining methods such as Hart's resorcinol-fuchsin staining and Masson's trichrome staining. Blood and urine samples of the deceased were collected within a maximum of four hours after death to determine the level of ethanol using the gas chromatography method. The data were centralized in the Statistical Package for the Social Sciences (SPSS) 18.0 database and processed using appropriate statistical functions, with a significant threshold of 95%. Ethical considerations The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki (1964) and its subsequent amendments. Ethical approval was obtained from the Institutional Review Board of the Department Pathological Anatomy and Forensic Medicine at Danylo Halytsky Lviv National Medical University (Approval number: 0123U201668). All data were anonymized and handled with strict confidentiality to preserve the privacy of the deceased and their families. Results Based on the data from the State Institution "Kyiv City Bureau of Forensic Medical Examination," in 2019, 2021, and 2023, 16,530 autopsies were performed. The proportion of deaths from cardiovascular diseases among all forensic medical examinations was 6.9% (1,143 autopsies). ACMP was diagnosed in 70 cases, representing 0.42% of the total autopsies for the indicated years. The number of forensic medical examinations performed each year did not differ significantly (p > 0.05) and, on average, was 5,510 ± 34 autopsies per year. Similarly, when comparing these years, no significant difference was found between the proportions of and ACMP (p > 0.05). Thus, the average number of autopsies with CVD was 381 ± 31 cases per year. The number of ACMP cases was 23 ± 45. It should be noted that the indicated years were chosen intentionally. 2019 was relatively calm, 2021 marked the height of the coronavirus infection, and 2023 was the second year of the Russian-Ukrainian war. Despite such significant influencing factors, the number of deaths and the structure of mortality did not change much during these periods (Fig. 1 ). The studied group with ACMP comprised 70 deceased people aged 16 to 40. We divided the age groups by decades (≤ 20 years, 21–30 years, and 31–40 years). Among the deceased, 9 (12.85%) individuals were under 20 years old, 12 (17.15%) were in the age group 21–30 years old, and 49 (70%) were aged 31–40 years old. Regarding the distribution by gender, men prevail almost threefold. Of the deceased, 51 (72.8%) were men, and 19 (27.2%) were women. Among the concomitant pathologies, chronic alcoholic hepatitis and hepatosis, and left-sided lower lobe bronchopneumonia were detected in a third of cases. In 8 (11.4%) cases, pulmonary embolism was detected, associated with the presence of parietal thrombi. The final cause of death of the deceased was acute cardiac and cardiorespiratory failure, which arose as a result of heart damage. According to the results of toxicological research, 45 (64.3%) of the deceased had a concentration of alcohol in the blood (in the resorption phase) of no more than two ppm and in the urine (in the elimination phase) of no more than 2–3 ppm. The remaining 35.7% had no ethanol in the studied biological fluids. Gross examination revealed significant dilatation of the heart chambers in all deceased. Typically, it was spherical. The mass of the myocardium ranged from 375 to 1100 g (average 685.6 ± 163.7 g). In 59 (84.2%) deceased, thickening of the left ventricular wall from 1.2 to 2.0 cm (average 1.6 ± 0.4 cm) was found, which is not typical for idiopathic dilated cardiomyopathy. Among them, 10 (14.2%) had hypertrophy of the walls of both ventricles, and 34 (48.5%) had hypertrophy of only the left ventricle. In the coronary arteries of deceased in the age group of 31–40 years, single atherosclerotic plaques in the stage of liposclerosis with a lesion area of 15–20% without signs of stenosis were determined. Visually, flaccidity and dullness of the myocardium on sections, a change in color to red-brown, and uneven hypertrophy of the ventricular walls were observed. In other organs, venous engorgement, an increase in the size of the liver and kidneys, fibrosis of the soft membranes of the brain, and pulmonary edema were observed. During microscopic examination of the myocardium, engorgement of small arteries and veins with leukocyte stasis and erythrocyte sludge phenomena was detected in all cases (Fig. 2 ). Sometimes, in 9 (12.85%) cases, the veins showed a separation of blood cellular elements from plasma, up to complete plasmatization. In a third of the cases, spasm of the intramural vessel with circular thickening and corrugation of elastic fibers was noted (Fig. 3 ). In 19 (27.2%) cases, “cushion-like” intimal protrusions into the vascular lumen were observed due to endothelial cell proliferation (Fig. 4 ). Moderate myocardial edema was noted in 24 (34.2%) cases (Fig. 5 ). Stromal myocardial fibrosis, ranging from focal to diffuse, was detected in almost all (88.5%) cases (Fig. 6 , 7 ). In some cases (15 cases, 21.4%), sclerotic thickening of individual areas of the endocardium and single small mural thrombi were noted. In a third of the cases, stromal small-focal lymphocytic infiltration (5 to 10 lymphocytes per field of view) was observed, with minor admixtures of segmented leukocytes. In 25 (35.7%) cases, areas of infiltrative proliferation of fatty tissue between muscle fibers in the thickness of both the left and right ventricles were observed, sometimes extending to the subendocardial zones (Fig. 8 ). The leading morphological features in all observations were uneven hypertrophy of cardiomyocytes characterized by large, irregularly shaped nuclei, wave-like deformation of cardiomyocytes, and significant areas of fragmentation of cardiomyocytes with focal myocytolysis (Fig. 9 ). In more than half of the cases, hypertrophy of muscle fibers, dullness, and granularity of the cytoplasm with lipofuscin accumulation were observed (Fig. 10 ). In 20% of all studied cases, a few small focal hemorrhages were observed in the interstitium. Discussion Data obtained from the study indicate a small proportion of cases with CSC in forensic medical practice. This represents 6.9% (1143 cases) of the total autopsies. The frequency of ACMP was also low and amounted to 70 (0.42%) cases. The average number of forensic medical examinations in Kyiv was 5510 ± 34 annual autopsies, the average number of autopsies with CVD was 381 ± 31 cases per year, and the number of ACMP cases was 23 ± 45. Comparing our results with the data of the State Statistics Service of Ukraine [ 13 ] over eight years (2015–2022), similar trends were found. According to the State Statistics Service, ACMP occupies a stable place in the mortality structure of Ukraine, accounting for on average 0.6% of all deaths, and tends to increase (from 0.57% in 2015 to 0.66% in 2022) despite a decrease in the total number of deaths (by 22,388 cases in 2015 and 2022, respectively), in particular due to diseases of the circulatory system (by 37,311 cases in 2015 and 2022, respectively) (table). In Western countries, alcoholism affects up to 10% of the adult population [ 14 , 15 ]. Worldwide, alcohol is responsible for 5.3% of all deaths [ 15 ], causing approximately 2.5 million deaths each year [ 17 ], while in the United States (USA), excessive alcohol consumption causes approximately 75,000 deaths each year [ 16 ]. In some countries, alcoholism has become a public health problem because of the high expenditures on the treatment of patients who consume excessive amounts of alcohol, and specifically, a study conducted in the USA estimated that the economic cost of alcohol consumption in 2002 was between $ 210 and $ 665 billion [ 18 ]. International studies show that in some countries, alcohol consumption begins in adolescence and increases after the age of 24 [ 19 , 20 ]. Due to the high social, medical, and economic costs of alcoholism worldwide, the World Health Organization (WHO) has implemented comprehensive strategies to reduce alcohol consumption [ 18 ]. By gender, ACMP is more common in men over 30 years of age, supported by other researchers' data [ 11 , 14 ]. At the same time, it has been shown that women develop ACMP more quickly at lower doses of alcohol than men [ 11 , 14 ]. Notably, in one-third of the cases in our study, ACMP developed in young men (16–25 years). Significant evidence in favor of the alcoholic genesis of cardiomyopathy is the collection of anamnestic data, which indicates long-term and constant alcohol consumption. Fang W. et al.(2018), in their studies, determined that individuals who consume > 80 g of alcohol daily for five years or more are prone to develop ACMP with heart failure [ 21 ]. However, Andersson C et al. (2022) believe that ethanol is only a trigger or a substance contributing to developing left ventricular dilation caused by other causes [ 22 ]. Not all individuals who consume excessive amounts of alcohol develop ACMP. It remains unclear why some people are able to consume excessive amounts of alcohol without developing ACMP. At the same time, light to moderate alcohol consumption is associated with the risk of adverse cardiovascular events [ 23 , 24 ]. To confirm the alcoholic genesis of cardiomyopathy, it is necessary to conduct a toxicological study of the blood and urine of the deceased for ethanol. Among our observations, only a third of the cases did not detect ethanol in the examined biological fluids. Compared with other known enzyme markers, the analysis for ethanol demonstrates greater sensitivity and specificity. Measurement of the amount of ethanol in blood samples taken during forensic medical examination is the main evidence of chronic alcohol abuse. Detection of ethanol in the blood, in parallel with the study data and post-mortem diagnostics, can help in the diagnosis of chronic ethanol intoxication and the clarification of controversial situations [ 25 ]. Modern forensic literature data indicate that the development of microangiopathy and multiorgan pathology with mandatory damage to the liver, heart, and brain accompanies alcohol abuse. The degree of structural and functional disorders of organs and systems is different and is determined by the type of alcohol intoxication. It is for chronic alcohol intoxication, without the formation of alcohol dependence (drunkenness), that the gradual development of ACMP is characteristic. E. Rubin and J. Doria (1999) believe that if drunkenness has not yet led to the last stage of the disease, namely, apparent changes in the heart, then the process can be reversed in approximately 30% of patients if they give up alcohol [ 26 ]. Typical pathomorphological changes in the heart in ACMP include uneven hypertrophy and dystrophic changes in cardiomyocytes, stromal and subendocardial fibrosis, small-focal inflammatory infiltration, sclerosis of intramural vessels, edema of myocardial stromal tissue, and lipomatosis. Our study confirms the observations of other authors who claim that chronic alcohol abuse reduces structural protein synthesis with sarcomere disorganization, which is histologically manifested by focal dissolution or vacuolization of cells and lysis of cardiomyocytes [ 27 ]. It has been proven that changes in the extracellular matrix are present in almost all cases of cardiomyopathies caused by excessive alcohol consumption [ 28 , 29 ]. The most striking is myocardial fibrosis, a consequence of the tissue regeneration after myocytes' apoptosis or necrosis. In this case, myocardial regeneration is ineffective, and the fibrosis process is significant, which leads to left ventricular dysfunction and heart failure [30, 31, 32]. Conclusions 1. A forensic medical study of 70 cases showed that chronic alcoholism can occur even in adolescence. Among the deceased, men aged over 30 predominated. 2. Typical macroscopic changes are cardiomegaly with heart dilation and hypertrophy of the wall of the left ventricles or both ventricles, which gives the heart a spherical shape. 3. Moderate atherosclerotic changes without signs of stenosis were detected in the coronary arteries of the deceased aged 31-40 years. 4. High levels of ethanol in the blood and urine were detected in 64.3% of the study group, which indicates alcohol consumption up to 96 hours prior to death. 5. Histological features of ACMP include parenchymal remodeling with dystrophic changes, uneven hypertrophy of cardiomyocytes against the background of stromal, perivascular and subendocardial fibrosis; intimal “cushion-like” protrusions and sclerosis of intramural arteries; microcirculatory disorders with sludge phenomenon; focal-diffuse lipomatosis of the wall of the left and right ventricles extending to the subendocardial sections. Myocardial fibrosis was focal or diffuse, developed mainly in the interstitial spaces around blood vessels, and was accompanied by the proliferation of connective tissue cells of fibroblasts, accompanied by a decrease in the number of myocytes. 6. The lack of specific immunological biomarkers for the diagnosis of alcoholic cardiomyopathy in the diagnostic criteria for ACMP complicates the pathomorphological comparison of ACMP with various forms of ischemic heart disease and the identification of ACMP as the leading cause of death. 7. The most common cause of death in ACMP is the progression of heart failure, the appearance of arrhythmia or cardioembolic complications, and the addition of bacterial infection manifesting as bronchopneumonia. Abbreviations ACMP alcoholic cardiomyopathy CVD cardiovascular diseases SPSS the Statistical Package for the Social Sciences Declarations Clinical trial number Not applicable. Authors’ contributions Y.K., O.M., and M.C. wrote the main manuscript text, O.M. prepared figures 1-9, and A.L. investigated and systematized the research material. All authors reviewed the manuscript. Funding This study received no financial support from governmental or private institutions. Data availability No datasets were generated or analysed during the current study. Human Ethics and Consent to Participate declarations : Not applicable. The study was conducted following ethical guidelines and approved by the Ukrainian Ministry of Health’s institutional review board, the Ethics Committee of the Faculty of Medicine, Danylo Halytsky Lviv National Medical University, and the 1964 Helsinki Declaration, and later amendments. Ethical approval Number by the Ukrainian MOH-IRB: Code # 0123U201668. Data availability No datasets were generated or analysed during the current study. Consent for publication All authors have consented to publish this manuscript. Competing interests The authors declare no competing interests. References Guzzo Merello G, Cobo Marcos M, Gallego Delgado M (2014) Garcia Pavia P Alcoholic cardiomyopathy. 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JACC Heart Fail , 3(1):78–86. https://doi.org/10.1016/j.jchf.2014.07.014 PMID: 25458176 Tables Table - Statistical information on the number of deaths from alcoholic cardiomyopathy (ACMP) among all deaths and cardiovascular diseases (CVD) in Ukraine for 2015-2022 * Year Total CVD ACMP abs. number % abs. number % abs. number % 2022 8 572408 100 367240 64,0 3379 0,66 2021 7 714263 100 430013 60,2 3526 0,49 2020 6 616835 100 408721 66,26 3597 0,58 2019 5 581114 100 389348 67,0 3718 0,64 2018 4 587665 100 392060 66,71 3933 0,67 2017 3 574123 100 384810 67,03 3423 0,60 2016 2 583631 100 392298 67,22 3218 0,55 2015 1 594796 100 404551 68,02 3414 0,57 *Note: 1 https://index.minfin.com.ua/ua/reference/people/deaths/2015/ 2 https://index.minfin.com.ua/ua/reference/people/deaths/2016/ 3 https://index.minfin.com.ua/ua/reference/people/deaths/2017/ 4 https://index.minfin.com.ua/ua/reference/people/deaths/2018/ 5 https://index.minfin.com.ua/ua/reference/people/deaths/2019/ 6 https://index.minfin.com.ua/ua/reference/people/deaths/2020/ 7 https://index.minfin.com.ua/ua/reference/people/deaths/2021/ 8 https://index.minfin.com.ua/ua/reference/people/deaths/2022/ Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 10 Jun, 2025 Reviewers agreed at journal 02 Jun, 2025 Reviews received at journal 01 Jun, 2025 Reviewers agreed at journal 01 Jun, 2025 Reviewers invited by journal 31 May, 2025 Editor assigned by journal 20 May, 2025 Submission checks completed at journal 20 May, 2025 First submitted to journal 08 May, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6623225","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":455094850,"identity":"44a9695a-72d4-452c-9ae2-9433dc901587","order_by":0,"name":"Oksana Malyk","email":"","orcid":"","institution":"Danylo Halytsky Lviv National Medical University","correspondingAuthor":false,"prefix":"","firstName":"Oksana","middleName":"","lastName":"Malyk","suffix":""},{"id":455094851,"identity":"66a04f81-8f7a-4d7c-be8d-5e09ea910e16","order_by":1,"name":"Yuliia Kuzyk","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+UlEQVRIie2PsUoDQRRF3/BgbcbUBoT4CROsRGV/xSWFjcFfeLKwaVbrtfIvUs/wINWEtIGp7C1msVlkC3cTtXM2peCcZi7DPVweQCTyBxGEpEF3SaLWvnuTo0FFfCtJZqpewQN2YK/Ic5b9x5CCVfagG8upslrx1cdyMkIQvr4LbFQZmXLLqNZ0w/MnNy0QcPy8DCtaek7UBjTPSyc6JcHjAcW0nqXaCOKL0qUHKSy3fKLWOTA0LhtWylfiU3urxnYF5pHcrECRB2+ZLmZcv60u05G9f/dN665fFrnxdUihr3Cm+81it0y/lPdMfsKu1wbLkUgk8k/5BPZVYKUAErLhAAAAAElFTkSuQmCC","orcid":"","institution":"Danylo Halytsky Lviv National Medical University","correspondingAuthor":true,"prefix":"","firstName":"Yuliia","middleName":"","lastName":"Kuzyk","suffix":""},{"id":455094852,"identity":"91d93fc1-9637-44c5-a864-4e4238317fc3","order_by":2,"name":"Anzhela Lishchynska","email":"","orcid":"","institution":"SSI “Main bureau of forensic medical examination of the Ministry of Health of Ukraine”","correspondingAuthor":false,"prefix":"","firstName":"Anzhela","middleName":"","lastName":"Lishchynska","suffix":""},{"id":455094855,"identity":"b27278bf-658d-4b44-a12e-20d3d3061aab","order_by":3,"name":"Monica Concato","email":"","orcid":"","institution":"University of Trieste","correspondingAuthor":false,"prefix":"","firstName":"Monica","middleName":"","lastName":"Concato","suffix":""}],"badges":[],"createdAt":"2025-05-08 19:38:20","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6623225/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6623225/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":82892359,"identity":"96185f7b-f90e-4935-8524-e01fb24d72fb","added_by":"auto","created_at":"2025-05-16 12:19:15","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":9928,"visible":true,"origin":"","legend":"\u003cp\u003eTotal number of autopsies, cardiovascular diseases, and cardiomyopathies for 2019, 2021, and 2023\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6623225/v1/c03ce0c58a9c3a3db472111a.png"},{"id":82893685,"identity":"da816fca-de0b-4ace-bc72-44449ecf3547","added_by":"auto","created_at":"2025-05-16 12:27:15","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":687560,"visible":true,"origin":"","legend":"\u003cp\u003eHyperemia and erythrocyte sludge in the myocardial microcirculation in alcoholic cardiomyopathy. Hematoxylin-Eosin x 250\u003c/p\u003e","description":"","filename":"Fig.2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6623225/v1/6995d03b36a72be7007f3822.jpg"},{"id":82892361,"identity":"12901a86-219b-4495-b0a0-88a7b7cc32b7","added_by":"auto","created_at":"2025-05-16 12:19:15","extension":"jpg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":893248,"visible":true,"origin":"","legend":"\u003cp\u003eCircular thickening of the wall of intramural vessels with \"corrugated\" elastic fibers (arrow) and sclerosis of the wall. Hart resorcin fuchsin x 100\u003c/p\u003e","description":"","filename":"Fig.3marks.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6623225/v1/4cd2e10cc08dc92b08effe9d.jpg"},{"id":82892362,"identity":"59196b81-8b73-4aa7-bed2-472b1d27c6ff","added_by":"auto","created_at":"2025-05-16 12:19:15","extension":"jpg","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":1264696,"visible":true,"origin":"","legend":"\u003cp\u003eSclerotic changes in the walls of intramural vessels with segmental hypertrophy (1) and perivascular sclerosis (2). Masson's trichrome x 60\u003c/p\u003e","description":"","filename":"Fig.4marks.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6623225/v1/8e691c12e13866633890cfef.jpg"},{"id":82892366,"identity":"f4043825-e37f-421a-a743-a4f6b982f2bd","added_by":"auto","created_at":"2025-05-16 12:19:15","extension":"jpg","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":1032537,"visible":true,"origin":"","legend":"\u003cp\u003eModerate diffuse edema of the myocardial stroma. Hematoxylin-Eosin x16\u003c/p\u003e","description":"","filename":"Fig.5.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6623225/v1/e548dbe0bdedad31e94bca9d.jpg"},{"id":82892370,"identity":"6a67340e-252c-4077-9129-d1d8e909a011","added_by":"auto","created_at":"2025-05-16 12:19:15","extension":"jpg","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":1188459,"visible":true,"origin":"","legend":"\u003cp\u003eFocal stromal myocardial fibrosis (1), multiple fragmentations of cardiomyocytes (2). Hematoxylin-Eosin x100\u003c/p\u003e","description":"","filename":"Fig.6marks.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6623225/v1/ef57bcb9800725f65233e9cb.jpg"},{"id":82893689,"identity":"0dbeba2d-7cc6-4329-8b70-4c644745fa56","added_by":"auto","created_at":"2025-05-16 12:27:15","extension":"jpg","order_by":7,"title":"Figure 7","display":"","copyAsset":false,"role":"figure","size":1248562,"visible":true,"origin":"","legend":"\u003cp\u003eDiffuse stromal fibrosis: proliferation of fibrous connective tissue (1) between unevenly hypertrophied cardiomyocytes (2). Masson's trichrome x100\u003c/p\u003e","description":"","filename":"Fig.7marks.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6623225/v1/9c3f79abb1156c9b2ee2b006.jpg"},{"id":82893691,"identity":"47f8a708-b801-4c49-8840-6909815f012a","added_by":"auto","created_at":"2025-05-16 12:27:15","extension":"jpg","order_by":8,"title":"Figure 8","display":"","copyAsset":false,"role":"figure","size":789445,"visible":true,"origin":"","legend":"\u003cp\u003eSignificant infiltrative growth of adipose tissue (1) between atrophied cardiomyocytes (2). Hematoxylin-Eosin x400\u003c/p\u003e","description":"","filename":"Fig.8marks.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6623225/v1/df9c17c3cc3889487401e9d3.jpg"},{"id":82892380,"identity":"fbbceb0b-d4db-445b-b89a-1d95b9148585","added_by":"auto","created_at":"2025-05-16 12:19:15","extension":"png","order_by":9,"title":"Figure 9","display":"","copyAsset":false,"role":"figure","size":488029,"visible":true,"origin":"","legend":"\u003cp\u003eDystrophic changes in cardiomyocytes in alcoholic cardiomyopathy:\u003c/p\u003e\n\u003cp\u003eA – wave-like deformation of fibers with significant edema of the stroma and interstitium. Hematoxylin-Eosin x100; B – fragmentation of fibers, moderate edema of the interstitium, and myocardial fibrosis. Masson’s trichrome x100\u003c/p\u003e","description":"","filename":"9.png","url":"https://assets-eu.researchsquare.com/files/rs-6623225/v1/91e13ce333e6e4e85dafd7b9.png"},{"id":82892382,"identity":"56b14eec-0edb-4194-a0e4-0db129c6846c","added_by":"auto","created_at":"2025-05-16 12:19:15","extension":"jpg","order_by":10,"title":"Figure 10","display":"","copyAsset":false,"role":"figure","size":727059,"visible":true,"origin":"","legend":"\u003cp\u003eHypertrophy and fragmentation of cardiomyocytes and accumulation of lipofuscin grains (arrow) in the cytoplasm. Hematoxylin-Eosin x400\u003c/p\u003e","description":"","filename":"Fig.10marks.jpg","url":"https://assets-eu.researchsquare.com/files/rs-6623225/v1/2ffb18b1349b67b2d3acde01.jpg"},{"id":82895385,"identity":"da30601f-dae7-4bb6-9389-00a54534205e","added_by":"auto","created_at":"2025-05-16 12:43:23","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":8891960,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6623225/v1/cef02857-abd0-47fe-ab2d-e2bc87f67d79.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003ePathomorphology Features of Alcoholic Cardiomyopathy\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSudden death due to cardiovascular diseases is most common in industrialized and urbanized countries and represents a major public health problem. In forensic practice, when examining the bodies of individuals aged 20\u0026ndash;60 years who have died suddenly, diagnostic difficulties often arise due to the lack of noticeable pathological changes in the cardiovascular system. One particularly challenging group includes people with a history of long-term alcohol consumption, where an insignificant concentration of ethanol in the blood or urine of the deceased, or its absence, precludes a diagnosis of death due to ethyl alcohol poisoning.\u003c/p\u003e \u003cp\u003eAlcohol is one of the most commonly consumed toxic substances worldwide [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. While daily low to moderate alcohol consumption has been shown to improve cardiovascular health in patients [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], chronic and excessive alcohol consumption can lead to progressive heart failure [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Chronic alcohol consumption or abuse is typically defined as daily consumption of more than 80\u0026ndash;90 g of alcohol per day (approximately eight drinks) for a period of at least five years [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Alcoholic cardiomyopathy (ACMP) is clinically defined as a form of dilated cardiomyopathy resulting from chronic alcohol abuse and is recognized by the World Health Organization as a distinct clinical entity, assigned the International Classification of Diseases (ICD-10) code I42.6. ACMP accounts for approximately 3.8% of all reported cases of cardiomyopathy and 21\u0026ndash;36% of all reported cases of non-ischemic dilated cardiomyopathy [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Clinically and histologically, ACMP is indistinguishable from idiopathic dilated cardiomyopathy. Therefore, a detailed patient history is considered essential for diagnosis [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Women develop ACMP with lower levels of alcohol intake compared to men, although the differences in the amount of alcohol required to develop the disease remain unknown [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Chronic alcohol exposure leads to reduced cardiomyocyte contractility, ventricular dilation, and myocardial fibrosis, which together constitute the morphological substrate for dilated cardiomyopathy [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Due to the absence of specific pathological changes, forensic identification of ACMP can only rely on the patient\u0026rsquo;s medical history and the exclusion of other causes of cardiomyopathy.\u003c/p\u003e \u003cp\u003eThis article reviews the forensic identification of ACMP and aims to provide reference material for forensic pathologists and clinicians.\u003c/p\u003e \u003cp\u003eThe study \u003cb\u003eaims\u003c/b\u003e to determine the characteristics of the age-sex distribution and the pathomorphological changes of the heart and vessels in forensic cases of ACMP.\u003c/p\u003e"},{"header":"Material and methods","content":"\u003cp\u003eSeventy cases of ACMP were analyzed at the State Statistical Office \"Kyiv City Bureau of Forensic Medical Examination\" over three years (2019, 2021, and 2023). Statistical information on the number of fatal cases of ACMP in Ukraine over eight years was processed according to the State Statistics Service of Ukraine (\u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://stat.gov.ua/uk/topics/okhorona-zdorovya\u003c/span\u003e\u003cspan address=\"https://stat.gov.ua/uk/topics/okhorona-zdorovya\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe forensic diagnosis of ACMP was established in deceased individuals who were chronic alcohol consumers, based on the presence of both pathomorphological changes of the heart and vessels, and the determination of ethanol levels in the blood and urine samples.\u003c/p\u003e \u003cp\u003eMacroscopically, the following cardiac lesions were detected during autopsy: left ventricular hypertrophy, dilated cardiomyopathy, and endocardial and myocardial fibrosis.\u003c/p\u003e \u003cp\u003eTissues from different parts of the heart (anterior and posterior walls, interventricular septum) and coronary arteries were examined histologically. Standard hematoxylin and eosin staining was used for paraffin sections, along with specific staining methods such as Hart's resorcinol-fuchsin staining and Masson's trichrome staining.\u003c/p\u003e \u003cp\u003eBlood and urine samples of the deceased were collected within a maximum of four hours after death to determine the level of ethanol using the gas chromatography method.\u003c/p\u003e \u003cp\u003eThe data were centralized in the Statistical Package for the Social Sciences (SPSS) 18.0 database and processed using appropriate statistical functions, with a significant threshold of 95%.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eEthical considerations\u003c/h2\u003e \u003cp\u003e The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki (1964) and its subsequent amendments. Ethical approval was obtained from the Institutional Review Board of the Department Pathological Anatomy and Forensic Medicine at Danylo Halytsky Lviv National Medical University (Approval number: 0123U201668). All data were anonymized and handled with strict confidentiality to preserve the privacy of the deceased and their families.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eBased on the data from the State Institution \"Kyiv City Bureau of Forensic Medical Examination,\" in 2019, 2021, and 2023, 16,530 autopsies were performed. The proportion of deaths from cardiovascular diseases among all forensic medical examinations was 6.9% (1,143 autopsies). ACMP was diagnosed in 70 cases, representing 0.42% of the total autopsies for the indicated years. The number of forensic medical examinations performed each year did not differ significantly (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) and, on average, was 5,510\u0026thinsp;\u0026plusmn;\u0026thinsp;34 autopsies per year. Similarly, when comparing these years, no significant difference was found between the proportions of and ACMP (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Thus, the average number of autopsies with CVD was 381\u0026thinsp;\u0026plusmn;\u0026thinsp;31 cases per year. The number of ACMP cases was 23\u0026thinsp;\u0026plusmn;\u0026thinsp;45. It should be noted that the indicated years were chosen intentionally. 2019 was relatively calm, 2021 marked the height of the coronavirus infection, and 2023 was the second year of the Russian-Ukrainian war. Despite such significant influencing factors, the number of deaths and the structure of mortality did not change much during these periods (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe studied group with ACMP comprised 70 deceased people aged 16 to 40. We divided the age groups by decades (\u0026le;\u0026thinsp;20 years, 21\u0026ndash;30 years, and 31\u0026ndash;40 years). Among the deceased, 9 (12.85%) individuals were under 20 years old, 12 (17.15%) were in the age group 21\u0026ndash;30 years old, and 49 (70%) were aged 31\u0026ndash;40 years old. Regarding the distribution by gender, men prevail almost threefold. Of the deceased, 51 (72.8%) were men, and 19 (27.2%) were women.\u003c/p\u003e \u003cp\u003eAmong the concomitant pathologies, chronic alcoholic hepatitis and hepatosis, and left-sided lower lobe bronchopneumonia were detected in a third of cases. In 8 (11.4%) cases, pulmonary embolism was detected, associated with the presence of parietal thrombi.\u003c/p\u003e \u003cp\u003eThe final cause of death of the deceased was acute cardiac and cardiorespiratory failure, which arose as a result of heart damage.\u003c/p\u003e \u003cp\u003eAccording to the results of toxicological research, 45 (64.3%) of the deceased had a concentration of alcohol in the blood (in the resorption phase) of no more than two ppm and in the urine (in the elimination phase) of no more than 2\u0026ndash;3 ppm. The remaining 35.7% had no ethanol in the studied biological fluids.\u003c/p\u003e \u003cp\u003eGross examination revealed significant dilatation of the heart chambers in all deceased. Typically, it was spherical. The mass of the myocardium ranged from 375 to 1100 g (average 685.6\u0026thinsp;\u0026plusmn;\u0026thinsp;163.7 g). In 59 (84.2%) deceased, thickening of the left ventricular wall from 1.2 to 2.0 cm (average 1.6\u0026thinsp;\u0026plusmn;\u0026thinsp;0.4 cm) was found, which is not typical for idiopathic dilated cardiomyopathy. Among them, 10 (14.2%) had hypertrophy of the walls of both ventricles, and 34 (48.5%) had hypertrophy of only the left ventricle. In the coronary arteries of deceased in the age group of 31\u0026ndash;40 years, single atherosclerotic plaques in the stage of liposclerosis with a lesion area of 15\u0026ndash;20% without signs of stenosis were determined. Visually, flaccidity and dullness of the myocardium on sections, a change in color to red-brown, and uneven hypertrophy of the ventricular walls were observed. In other organs, venous engorgement, an increase in the size of the liver and kidneys, fibrosis of the soft membranes of the brain, and pulmonary edema were observed.\u003c/p\u003e \u003cp\u003eDuring microscopic examination of the myocardium, engorgement of small arteries and veins with leukocyte stasis and erythrocyte sludge phenomena was detected in all cases (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eSometimes, in 9 (12.85%) cases, the veins showed a separation of blood cellular elements from plasma, up to complete plasmatization. In a third of the cases, spasm of the intramural vessel with circular thickening and corrugation of elastic fibers was noted (Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn 19 (27.2%) cases, \u0026ldquo;cushion-like\u0026rdquo; intimal protrusions into the vascular lumen were observed due to endothelial cell proliferation (Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eModerate myocardial edema was noted in 24 (34.2%) cases (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e5\u003c/span\u003e). Stromal myocardial fibrosis, ranging from focal to diffuse, was detected in almost all (88.5%) cases (Fig.\u0026nbsp;\u003cspan refid=\"Fig6\" class=\"InternalRef\"\u003e6\u003c/span\u003e, \u003cspan refid=\"Fig7\" class=\"InternalRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn some cases (15 cases, 21.4%), sclerotic thickening of individual areas of the endocardium and single small mural thrombi were noted.\u003c/p\u003e \u003cp\u003eIn a third of the cases, stromal small-focal lymphocytic infiltration (5 to 10 lymphocytes per field of view) was observed, with minor admixtures of segmented leukocytes.\u003c/p\u003e \u003cp\u003eIn 25 (35.7%) cases, areas of infiltrative proliferation of fatty tissue between muscle fibers in the thickness of both the left and right ventricles were observed, sometimes extending to the subendocardial zones (Fig.\u0026nbsp;\u003cspan refid=\"Fig8\" class=\"InternalRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe leading morphological features in all observations were uneven hypertrophy of cardiomyocytes characterized by large, irregularly shaped nuclei, wave-like deformation of cardiomyocytes, and significant areas of fragmentation of cardiomyocytes with focal myocytolysis (Fig.\u0026nbsp;\u003cspan refid=\"Fig9\" class=\"InternalRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn more than half of the cases, hypertrophy of muscle fibers, dullness, and granularity of the cytoplasm with lipofuscin accumulation were observed (Fig.\u0026nbsp;\u003cspan refid=\"Fig10\" class=\"InternalRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn 20% of all studied cases, a few small focal hemorrhages were observed in the interstitium.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003e Data obtained from the study indicate a small proportion of cases with CSC in forensic medical practice. This represents 6.9% (1143 cases) of the total autopsies. The frequency of ACMP was also low and amounted to 70 (0.42%) cases. The average number of forensic medical examinations in Kyiv was 5510\u0026thinsp;\u0026plusmn;\u0026thinsp;34 annual autopsies, the average number of autopsies with CVD was 381\u0026thinsp;\u0026plusmn;\u0026thinsp;31 cases per year, and the number of ACMP cases was 23\u0026thinsp;\u0026plusmn;\u0026thinsp;45. Comparing our results with the data of the State Statistics Service of Ukraine [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] over eight years (2015\u0026ndash;2022), similar trends were found. According to the State Statistics Service, ACMP occupies a stable place in the mortality structure of Ukraine, accounting for on average 0.6% of all deaths, and tends to increase (from 0.57% in 2015 to 0.66% in 2022) despite a decrease in the total number of deaths (by 22,388 cases in 2015 and 2022, respectively), in particular due to diseases of the circulatory system (by 37,311 cases in 2015 and 2022, respectively) (table).\u003c/p\u003e \u003cp\u003eIn Western countries, alcoholism affects up to 10% of the adult population [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Worldwide, alcohol is responsible for 5.3% of all deaths [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e], causing approximately 2.5\u0026nbsp;million deaths each year [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], while in the United States (USA), excessive alcohol consumption causes approximately 75,000 deaths each year [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. In some countries, alcoholism has become a public health problem because of the high expenditures on the treatment of patients who consume excessive amounts of alcohol, and specifically, a study conducted in the USA estimated that the economic cost of alcohol consumption in 2002 was between \u003cspan\u003e$\u003c/span\u003e210 and \u003cspan\u003e$\u003c/span\u003e665\u0026nbsp;billion [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. International studies show that in some countries, alcohol consumption begins in adolescence and increases after the age of 24 [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Due to the high social, medical, and economic costs of alcoholism worldwide, the World Health Organization (WHO) has implemented comprehensive strategies to reduce alcohol consumption [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBy gender, ACMP is more common in men over 30 years of age, supported by other researchers' data [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. At the same time, it has been shown that women develop ACMP more quickly at lower doses of alcohol than men [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Notably, in one-third of the cases in our study, ACMP developed in young men (16\u0026ndash;25 years).\u003c/p\u003e \u003cp\u003eSignificant evidence in favor of the alcoholic genesis of cardiomyopathy is the collection of anamnestic data, which indicates long-term and constant alcohol consumption. Fang W. et al.(2018), in their studies, determined that individuals who consume\u0026thinsp;\u0026gt;\u0026thinsp;80 g of alcohol daily for five years or more are prone to develop ACMP with heart failure [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. However, Andersson C et al. (2022) believe that ethanol is only a trigger or a substance contributing to developing left ventricular dilation caused by other causes [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Not all individuals who consume excessive amounts of alcohol develop ACMP. It remains unclear why some people are able to consume excessive amounts of alcohol without developing ACMP. At the same time, light to moderate alcohol consumption is associated with the risk of adverse cardiovascular events [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTo confirm the alcoholic genesis of cardiomyopathy, it is necessary to conduct a toxicological study of the blood and urine of the deceased for ethanol. Among our observations, only a third of the cases did not detect ethanol in the examined biological fluids. Compared with other known enzyme markers, the analysis for ethanol demonstrates greater sensitivity and specificity. Measurement of the amount of ethanol in blood samples taken during forensic medical examination is the main evidence of chronic alcohol abuse. Detection of ethanol in the blood, in parallel with the study data and post-mortem diagnostics, can help in the diagnosis of chronic ethanol intoxication and the clarification of controversial situations [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eModern forensic literature data indicate that the development of microangiopathy and multiorgan pathology with mandatory damage to the liver, heart, and brain accompanies alcohol abuse. The degree of structural and functional disorders of organs and systems is different and is determined by the type of alcohol intoxication. It is for chronic alcohol intoxication, without the formation of alcohol dependence (drunkenness), that the gradual development of ACMP is characteristic. E. Rubin and J. Doria (1999) believe that if drunkenness has not yet led to the last stage of the disease, namely, apparent changes in the heart, then the process can be reversed in approximately 30% of patients if they give up alcohol [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTypical pathomorphological changes in the heart in ACMP include uneven hypertrophy and dystrophic changes in cardiomyocytes, stromal and subendocardial fibrosis, small-focal inflammatory infiltration, sclerosis of intramural vessels, edema of myocardial stromal tissue, and lipomatosis. Our study confirms the observations of other authors who claim that chronic alcohol abuse reduces structural protein synthesis with sarcomere disorganization, which is histologically manifested by focal dissolution or vacuolization of cells and lysis of cardiomyocytes [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. It has been proven that changes in the extracellular matrix are present in almost all cases of cardiomyopathies caused by excessive alcohol consumption [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. The most striking is myocardial fibrosis, a consequence of the tissue regeneration after myocytes' apoptosis or necrosis. In this case, myocardial regeneration is ineffective, and the fibrosis process is significant, which leads to left ventricular dysfunction and heart failure [30, 31, 32].\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003e1. A forensic medical study of 70 cases showed that chronic alcoholism can occur even in adolescence. Among the deceased, men aged over 30 predominated.\u003c/p\u003e\n\u003cp\u003e2. Typical macroscopic changes are cardiomegaly with heart dilation and hypertrophy of the wall of the left ventricles or both ventricles, which gives the heart a spherical shape.\u003c/p\u003e\n\u003cp\u003e3. Moderate atherosclerotic changes without signs of stenosis were detected in the coronary arteries of the deceased aged 31-40 years.\u003c/p\u003e\n\u003cp\u003e4. High levels of ethanol in the blood and urine were detected in 64.3% of the study group, which indicates alcohol consumption up to 96 hours prior to death.\u003c/p\u003e\n\u003cp\u003e5. Histological features of ACMP include parenchymal remodeling with dystrophic changes, uneven hypertrophy of cardiomyocytes against the background of stromal, perivascular and subendocardial fibrosis; intimal \u0026ldquo;cushion-like\u0026rdquo; protrusions and sclerosis of intramural arteries; microcirculatory disorders with sludge phenomenon; focal-diffuse lipomatosis of the wall of the left and right ventricles extending to the subendocardial sections. Myocardial fibrosis was focal or diffuse, developed mainly in the interstitial spaces around blood vessels, and was accompanied by the proliferation of connective tissue cells of fibroblasts, accompanied by a decrease in the number of myocytes.\u003c/p\u003e\n\u003cp\u003e6. The lack of specific immunological biomarkers for the diagnosis of alcoholic cardiomyopathy in the diagnostic criteria for ACMP complicates the pathomorphological comparison of ACMP with various forms of ischemic heart disease and the identification of ACMP as the leading cause of death.\u003c/p\u003e\n\u003cp\u003e7. The most common cause of death in ACMP is the progression of heart failure, the appearance of arrhythmia or cardioembolic complications, and the addition of bacterial infection manifesting as bronchopneumonia.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eACMP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ealcoholic cardiomyopathy\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCVD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ecardiovascular diseases\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSPSS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ethe Statistical Package for the Social Sciences\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eY.K., O.M., and M.C. wrote the main manuscript text, O.M. prepared figures 1-9, and A.L. investigated and systematized the research material. All authors reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study received no financial support from governmental or private institutions.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo datasets were generated or analysed during the current study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHuman Ethics and Consent to Participate declarations\u003c/strong\u003e:\u0026nbsp;Not applicable.\u003c/p\u003e\n\u003cp\u003eThe study was conducted following ethical guidelines and approved by the Ukrainian Ministry of Health\u0026rsquo;s institutional review board, the Ethics Committee of the Faculty of Medicine, Danylo Halytsky Lviv National Medical University, and the 1964 Helsinki Declaration, and later amendments. Ethical approval Number by the Ukrainian MOH-IRB: Code #\u0026nbsp;0123U201668.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo datasets were generated or analysed during the current study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll authors have consented to publish this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eGuzzo Merello G, Cobo Marcos M, Gallego Delgado M (2014) Garcia Pavia P Alcoholic cardiomyopathy. 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Med (Baltim) 97(39):e12259. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1097/MD.0000000000012259\u003c/span\u003e\u003cspan address=\"10.1097/MD.0000000000012259\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003ePMID: 30278496 PMCID: PMC6181549\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGuzzo-Merello G, Segovia J, Dominguez F, Cobo-Marcos M, Gomez-Bueno M, Avellana P, Millan I, Alonso-Pulpon L, Garcia-Pavia P (2015) Natural history and prognostic factors in alcoholic cardiomyopathy. \u003cem\u003eJACC Heart Fail\u003c/em\u003e, 3(1):78\u0026ndash;86. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.jchf.2014.07.014\u003c/span\u003e\u003cspan address=\"10.1016/j.jchf.2014.07.014\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e PMID: 25458176\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable - Statistical information on the number of deaths from alcoholic cardiomyopathy (ACMP) among all deaths and cardiovascular diseases (CVD) in Ukraine for 2015-2022 *\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003eYear \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003eCVD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 183px;\"\u003e\n \u003cp\u003eACMP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003eabs. number\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003eabs. number\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003eabs. number\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e%\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e2022\u003csup\u003e8\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e572408\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e367240\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e64,0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e3379\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0,66\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e2021\u003csup\u003e7\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e714263\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e430013\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e60,2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e3526\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0,49\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e2020\u003csup\u003e6\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e616835\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e408721\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e66,26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e3597\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0,58\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e2019\u003csup\u003e5\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e581114\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e389348\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e67,0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e3718\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0,64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e2018\u003csup\u003e4\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e587665\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e392060\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e66,71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e3933\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0,67\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e2017\u003csup\u003e3\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e574123\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e384810\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e67,03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e3423\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0,60\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e2016\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e583631\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e392298\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e67,22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e3218\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0,55\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e2015\u003csup\u003e1\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e594796\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e404551\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e68,02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e3414\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 92px;\"\u003e\n \u003cp\u003e0,57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e*Note:\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e1\u003c/sup\u003ehttps://index.minfin.com.ua/ua/reference/people/deaths/2015/\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e2\u003c/sup\u003ehttps://index.minfin.com.ua/ua/reference/people/deaths/2016/\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e3\u003c/sup\u003ehttps://index.minfin.com.ua/ua/reference/people/deaths/2017/\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e4\u003c/sup\u003ehttps://index.minfin.com.ua/ua/reference/people/deaths/2018/\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e5\u003c/sup\u003ehttps://index.minfin.com.ua/ua/reference/people/deaths/2019/\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e6\u003c/sup\u003ehttps://index.minfin.com.ua/ua/reference/people/deaths/2020/\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e7\u003c/sup\u003ehttps://index.minfin.com.ua/ua/reference/people/deaths/2021/\u003c/p\u003e\n\u003cp\u003e\u003csup\u003e8\u003c/sup\u003ehttps://index.minfin.com.ua/ua/reference/people/deaths/2022/\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"egyptian-journal-of-forensic-sciences","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejfs","sideBox":"Learn more about [Egyptian Journal of Forensic Sciences](http://ejfs.springeropen.com)","snPcode":"41935","submissionUrl":"https://submission.springernature.com/new-submission/41935/3?","title":"Egyptian Journal of Forensic Sciences","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"chronic alcohol consumption, cardiac changes, ethyl glucuronide, alcoholic cardiomyopathy","lastPublishedDoi":"10.21203/rs.3.rs-6623225/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6623225/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eAlcohol is the most well-known toxic substance, and its negative impact on human health and lifestyle is well-documented. Chronic alcoholism is a pathological condition that occurs as a result of excessive alcohol consumption and is most commonly observed in young and middle-aged men. In our study, changes in the left ventricular myocardium due to alcohol consumption were investigated in 70 individuals who died at home under suspicious circumstances and whose bodies were sent to the State Statistical Office \"Kyiv City Bureau of Forensic Medical Examination\" to determine the cause of death. In 64.3% of cases, a high level of ethyl glucuronide was found in the blood, indicating alcohol consumption within 96 hours prior to death. Heart lesions were represented by dilated cardiomyopathy and myocardial fibrosis.\u003c/p\u003e","manuscriptTitle":"Pathomorphology Features of Alcoholic Cardiomyopathy","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-16 12:19:10","doi":"10.21203/rs.3.rs-6623225/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-06-10T16:20:44+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"268269492182001208689081623611188522875","date":"2025-06-02T17:39:45+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-06-01T09:34:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"83495487665236487842576706169867243779","date":"2025-06-01T08:51:18+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-05-31T17:35:31+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-05-20T07:25:13+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-05-20T05:36:36+00:00","index":"","fulltext":""},{"type":"submitted","content":"Egyptian Journal of Forensic Sciences","date":"2025-05-08T19:34:20+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"egyptian-journal-of-forensic-sciences","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"ejfs","sideBox":"Learn more about [Egyptian Journal of Forensic Sciences](http://ejfs.springeropen.com)","snPcode":"41935","submissionUrl":"https://submission.springernature.com/new-submission/41935/3?","title":"Egyptian Journal of Forensic Sciences","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"e79220de-14ee-4aa9-95d4-cf9ed2753358","owner":[],"postedDate":"May 16th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-04-30T06:56:31+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-16 12:19:10","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6623225","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6623225","identity":"rs-6623225","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}