Heart and Liver MRI Changes Track Alcohol Exposure

In a prospective cross-sectional study published in Cardiovascular Diabetology, researchers identified specific abnormalities in heart and liver magnetic resonance imaging (MRI) among men with alcohol use disorder (AUD) before they began abstinence treatment. The study, led by Zhen Wang and colleagues, focused on 88 consecutive men with AUD and 63 healthy male controls. The central finding was that participants with AUD exhibited measurable changes in myocardial deformation and extracellular space, as well as increased liver fat, even though their left ventricular ejection fraction remained similar to that of the healthy controls. This suggests that cardiac and liver damage may be detectable via MRI before the onset of overt cardiomyopathy, which is typically recognized only after ventricular dilatation or a significant reduction in pumping efficiency.

The research was conducted between February 2022 and October 2024, involving a total of 151 participants with a mean age of 47.4 years. The primary cardiac outcomes prespecified for the study were left ventricular global longitudinal strain (LVGLS) and extracellular volume fraction (ECV). Additionally, the researchers evaluated cardiac and liver proton density fat fractions (PDFF) to quantify the amount of fat present in the heart and liver tissues.

The AUD group had a mean ejection fraction of 59.2% with a standard deviation of 8.0, while the control group had a mean of 61.1% with a standard deviation of 6.8, resulting in a P-value of 0.11. Participants with AUD had less negative LVGLS, a value of -15.76% compared to -17.63% in the controls, with a P-value of less than 0.001.

Furthermore, the AUD group displayed a higher extracellular volume fraction (ECV), measured at 28.14% compared to 25.42% in the controls, also with a P-value of less than 0.001. The study also found higher cardiac and liver proton density fat fractions in the AUD participants, indicating increased lipid accumulation in both organs.

To understand the impact of alcohol consumption on these changes, the researchers analyzed the total lifetime dose of ethanol (TLDE). Multivariable linear regression was used to assess group differences and associations with this cumulative exposure. After adjusting for other variables, having AUD was associated with a 1.49-percentage-point less negative LVGLS and a 2.11-percentage-point higher ECV compared to controls. More specifically, for every 5-kg/kg increase in TLDE, there was an associated 0.78-percentage-point less negative LVGLS and a 0.75-percentage-point higher ECV, with both associations showing P-values of less than 0.001. This dose-response relationship suggests that the degree of cardiac and liver MRI abnormalities increases with the cumulative amount of alcohol consumed over a lifetime.

The study also explored the relationship between cardiac and liver abnormalities. Using Spearman correlation and multivariable regression, the researchers found that liver PDFF remained associated with cardiac PDFF and ECV even after additional adjustment for the total lifetime dose of ethanol. This indicates that liver fat accumulation is linked to myocardial fat and extracellular space changes, independent of the total amount of alcohol consumed.

The authors conclude that before abstinence treatment, men with AUD have abnormalities in myocardial deformation and extracellular space despite similar ejection fractions. The cardiac and liver MRI abnormalities increase with cumulative ethanol exposure, and liver fat is related to myocardial fat and ECV. However, the study has limitations inherent to its cross-sectional design, which prevents the establishment of causality or the assessment of reversibility. The researchers emphasize that longitudinal studies are needed to determine whether these MRI-detected changes are reversible with abstinence and what their long-term clinical significance is. While the findings suggest that cardiovascular health merits attention in patients with substantial alcohol exposure, the role of cardiac MRI in screening or risk stratification requires further prospective evaluation.

Subject of Research: Cardiac and liver MRI characteristics in men with alcohol use disorder

Article Title: Cardiac and liver MRI characteristics across cumulative alcohol exposure in men with alcohol use disorder before abstinence treatment

Article References: Wang, Z., Chen, J., Li, Y., Zheng, Z., Jiang, Y., Li, Z., Wang, J., Pang, L., Yu, Y., Zhao, R., Tang, J., & Li, X. (2026). Cardiac and liver MRI characteristics across cumulative alcohol exposure in men with alcohol use disorder before abstinence treatment. Cardiovascular Diabetology. https://doi.org/10.1186/s12933-026-03409-4

Image Credits: AI Generated

DOI: 10.1186/s12933-026-03409-4

Keywords: alcohol use disorder, cardiac MRI, liver MRI, global longitudinal strain, extracellular volume, cumulative alcohol exposure, cardiomyopathy, proton density fat fraction, cross-sectional study, Cardiovascular Diabetology, Cardiac, liver