Carvedilol Therapy Improved Left Ventricular Function in a Patient With Arrhythmogenic Right Ventricular Cardiomyopathy
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- Hiroi Yukio
- Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine
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- Fujiu Katsuhito
- Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine
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- Komatsu Shuhei
- Department of Radiology, University of Tokyo Graduate School of Medicine
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- Sonoda Makoto
- Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine
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- Sakomura Yasunari
- Department of Cardiology, Heart Institute of Japan, Tokyo Women's University
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- Imai Yasushi
- Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine
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- Oishi Yumi
- Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine
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- Nakamura Fumitaka
- Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine
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- Ajiki Kohsuke
- Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine
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- Hayami Noriyuki
- Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine
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- Murakawa Yuji
- Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine
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- Ohno Minoru
- Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine
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- Hirata Yasunobu
- Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine
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- Ohtomo Kuni
- Department of Radiology, University of Tokyo Graduate School of Medicine
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- Nagai Ryozo
- Department of Cardiovascular Medicine, University of Tokyo Graduate School of Medicine
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抄録
An asymptomatic 35 year-old man was referred to our hospital because of abnormal ECG findings. The ECG showed complete right bundle branch block and left anterior hemiblock. Echocardiography revealed a moderately enlarged right ventricle (RV) and an apical aneurysm. RV wall motion showed diffusely moderate impairment, while the systolic function of the left ventricle (LV) was slightly decreased. The ejection fractions (EF) of the RV and LV were calculated as 28.1% and 41.9% by Simpson's method using multiple cardiac computed tomography (CT) scans. A 24 hour ambulatory ECG showed only 372 single premature ventricular contractions (PVC). Cardiac catheterizaion revealed that the RV was enlarged with prominent trabeculation and decreased motion. In an electrophysiologic study, neither electrical stimulation of the RV nor electrical stimulation plus isoproterenol infusion could induce ventricular tachycardia. Pathological examination of a biopsy from the interventricular septum of the RV revealed fibrofatty change in the myocardium. Based on these results, we made a diagnosis of arrhythmogenic right ventriclular cardiomyopathy (ARVC) and administered 5 mg of carvedilol. Sixty days after the initiation of carvedilol therapy, we performed repeat cardiac CT. The EF of the LV was markedly improved from 41.9% to 62.0%, although the EF of the RV was not changed. The number of PVCs showed no change. This case suggests that carvedilol is not only useful for controlling arrhythmia but also for improving left ventriclular function in some patients with ARVC. Sympathetic overactivity is reported to cause sudden death, so carvedilol may be a first-line drug for some patients with ARVC. <br>
収録刊行物
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- Ｊａｐａｎｅｓｅ Ｈｅａｒｔ Ｊｏｕｒｎａｌ
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Ｊａｐａｎｅｓｅ Ｈｅａｒｔ Ｊｏｕｒｎａｌ 45 (1), 169-177, 2004
International Heart Journal刊行会
