Alcoholic cardiomyopathy presenting with severe circulatory failure requiring mechanical circulatory support: A systematic review.

BACKGROUND: Alcoholic cardiomyopathy (ACM) is a potentially reversible form of dilated cardiomyopathy associated with chronic excessive alcohol consumption. Although recovery of left ventricular function after alcohol abstinence has been reported, the clinical course of patients presenting with cardiogenic shock or cardiac arrest requiring mechanical circulatory support (MCS) remains poorly characterized. This study aimed to evaluate survival outcomes and myocardial recovery in patients with ACM presenting with severe circulatory failure.

METHODS: A systematic literature search was conducted in PubMed, Web of Science, Google Scholar, and Ichushi-Web from database inception to February 28, 2026. Studies describing patients with ACM presenting with cardiogenic shock or severe circulatory failure requiring temporary MCS (including ECMO, Impella, intra-aortic balloon pump, or LVAD) were included. Extracted data included patient characteristics, type of circulatory support, survival outcomes, and recovery of left ventricular function.

RESULTS: Five studies (three case reports and two case series), including 10 patients, were identified. The median age was 43 years (IQR, 38-46), and 9 of 10 patients (90%) were male. The median baseline LVEF was 15% (IQR, 15-20%). Cardiac arrest occurred in 3 patients (30%). Veno-arterial extracorporeal support, including VA-ECMO/PCPS, was used in 9 patients (90%), Impella in 1 patient (10%), and LVAD support in 3 patients (30%). One patient ultimately underwent heart transplantation. All published cases survived. Among patients with available follow-up data, the median LVEF improved to 55% (IQR, 45-60%), representing a median absolute increase of approximately 40 percentage points.

CONCLUSIONS: Published case-based evidence suggests that alcoholic cardiomyopathy may retain clinically meaningful reversibility even in selected patients with severe circulatory failure requiring mechanical circulatory support. Although favorable outcomes may be overrepresented in published reports, awareness of this potentially reversible phenotype may support timely recognition and appropriate management of severe circulatory failure.