Abstract：
BACKGROUND: The treatment of dilated cardiomyopathy (DCM) has recently been greatly improved, especially with the widespread use of sacubitril/valsartan (ARNI) combination therapy. We know that ARNI-like drugs can significantly improve the symptoms of heart failure with reducing ejection fraction. However, clinical studies evaluating the safety and efficacy of ARNI in DCM-associated arrhythmia are limited, and whether individuals with arrhythmia would benefit from ARNI remains controversial. In this case, we report a patient with complete left bundle branch block (CLBBB) associated with DCM whose CLBBB returned to normal after treatment with ARNI.
METHODS: A 38-year-old man was admitted to the hospital for 20 days for idiopathic paroxysmal dyspnea. He presented with exacerbated dyspnea symptoms at night, accompanied by cough and sputum.
METHODS: Physical examination revealed a grade 4/6 systolic murmur could be heard in the apical area of the heart and mild edema was present in both lower limbs. Laboratory examination found that the B-type natriuretic peptide was significantly increased. Echocardiography indicated left atrial internal diameter, right ventricular internal diameter, and left ventricular diastolic diameter were enlarged and ejection fraction was significantly decreased. Besides, the pulsation of the wall was diffusely attenuated. Electrocardiogram was suggestive of tachycardia and CLBBB. A diagnosis of DCM with CLBBB was considered based on a comprehensive evaluation of the physical examination, laboratory examination, echocardiography and electrocardiogram.
METHODS: The patient was treated with ARNI at a dose of 50 mg (twice a day) at first, gradually increasing to the target dose (200 mg, twice a day) in the following 9 months as shown in Table 1, along with metoprolol 25 mg (once a day [qd]), diuretics 20 mg (qd), and aldosterone 20 mg (qd).
RESULTS: After treatment with ARNI during the 9-month follow-up, the patient\'s symptoms improved, and CLBBB returned to normal.
CONCLUSIONS: Clinical studies evaluating the safety and efficacy of ARNI in DCM-associated arrhythmia are limited, and whether individuals with arrhythmia would benefit from ARNI remains controversial. This report will help to instruct the clinical treatment of DCM patients with CLBBB and the potential application of ARNI.
METHODS: A 38-year-old man was admitted to the hospital for 20 days for idiopathic paroxysmal dyspnea. He presented with exacerbated dyspnea symptoms at night, accompanied by cough and sputum.
METHODS: Physical examination revealed a grade 4/6 systolic murmur could be heard in the apical area of the heart and mild edema was present in both lower limbs. Laboratory examination found that the B-type natriuretic peptide was significantly increased. Echocardiography indicated left atrial internal diameter, right ventricular internal diameter, and left ventricular diastolic diameter were enlarged and ejection fraction was significantly decreased. Besides, the pulsation of the wall was diffusely attenuated. Electrocardiogram was suggestive of tachycardia and CLBBB. A diagnosis of DCM with CLBBB was considered based on a comprehensive evaluation of the physical examination, laboratory examination, echocardiography and electrocardiogram.
METHODS: The patient was treated with ARNI at a dose of 50 mg (twice a day) at first, gradually increasing to the target dose (200 mg, twice a day) in the following 9 months as shown in Table 1, along with metoprolol 25 mg (once a day [qd]), diuretics 20 mg (qd), and aldosterone 20 mg (qd).
RESULTS: After treatment with ARNI during the 9-month follow-up, the patient\'s symptoms improved, and CLBBB returned to normal.
CONCLUSIONS: Clinical studies evaluating the safety and efficacy of ARNI in DCM-associated arrhythmia are limited, and whether individuals with arrhythmia would benefit from ARNI remains controversial. This report will help to instruct the clinical treatment of DCM patients with CLBBB and the potential application of ARNI.
摘要：
背景：扩张型心肌病（DCM）的治疗方法最近得到了极大的改善，特别是随着沙库巴曲/缬沙坦（ARNI）联合治疗的广泛使用。我们知道，ARNI样药物可以显着改善心力衰竭的症状，降低射血分数。然而,评估ARNI在DCM相关心律失常中的安全性和有效性的临床研究有限，心律失常患者是否会从ARNI获益仍存在争议.在这种情况下,我们报告了1例与DCM相关的完全性左束支传导阻滞(CLBBB)患者,其CLBBB在接受ARNI治疗后恢复正常.
方法：一名38岁男性因特发性阵发性呼吸困难入院20天。他晚上出现呼吸困难症状加剧，伴有咳嗽和痰。
方法：体格检查显示，心脏的心尖区可听到4/6级收缩期杂音，双下肢均有轻度水肿。实验室检查发现B型钠尿肽明显升高。超声心动图示左房内径，右心室内径,左心室舒张内径增大，射血分数明显降低。此外,壁的脉动被扩散衰减。心电图提示心动过速和CLBBB。基于对体格检查的综合评估，考虑了患有CLBBB的DCM的诊断。实验室检查,超声心动图和心电图。
方法：患者首先接受50mg（每天两次）的ARNI治疗，逐渐增加到目标剂量（200毫克，每天两次）在接下来的9个月中，如表1所示，以及美托洛尔25毫克（每天一次[qd]），利尿剂20毫克（qd），醛固酮20mg(qd)。
结果：在9个月随访期间接受ARNI治疗后，病人的症状有所改善，CLBBB恢复正常。
结论：评估ARNI在DCM相关心律失常中的安全性和有效性的临床研究有限，心律失常患者是否会从ARNI获益仍存在争议.本报告将有助于指导DCM合并CLBBB患者的临床治疗和ARNI的潜在应用。
方法：一名38岁男性因特发性阵发性呼吸困难入院20天。他晚上出现呼吸困难症状加剧，伴有咳嗽和痰。
方法：体格检查显示，心脏的心尖区可听到4/6级收缩期杂音，双下肢均有轻度水肿。实验室检查发现B型钠尿肽明显升高。超声心动图示左房内径，右心室内径,左心室舒张内径增大，射血分数明显降低。此外,壁的脉动被扩散衰减。心电图提示心动过速和CLBBB。基于对体格检查的综合评估，考虑了患有CLBBB的DCM的诊断。实验室检查,超声心动图和心电图。
方法：患者首先接受50mg（每天两次）的ARNI治疗，逐渐增加到目标剂量（200毫克，每天两次）在接下来的9个月中，如表1所示，以及美托洛尔25毫克（每天一次[qd]），利尿剂20毫克（qd），醛固酮20mg(qd)。
结果：在9个月随访期间接受ARNI治疗后，病人的症状有所改善，CLBBB恢复正常。
结论：评估ARNI在DCM相关心律失常中的安全性和有效性的临床研究有限，心律失常患者是否会从ARNI获益仍存在争议.本报告将有助于指导DCM合并CLBBB患者的临床治疗和ARNI的潜在应用。
