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. 2001 Jul;86(1):e4. doi: 10.1136/heart.86.1.e4

Effects of carvedilol on left ventricular function, mass, and scintigraphic findings in isolated left ventricular non-compaction

M Toyono, C Kondo, Y Nakajima, M Nakazawa, K Momma, K Kusakabe
PMCID: PMC1729815  PMID: 11410581

Abstract

A four month old infant with isolated left ventricular non-compaction was treated with carvedilol. Haemodynamic studies and various types of imaging—including echocardiography, radiographic angiography, magnetic resonance imaging, and single photon emission computed tomography with 201Tl, 123I-β-methyliodophenylpentadecanoic acid (BMIPP), and 123I-metaiodobenzylguanidine (MIBG)—were performed before and 14 months after treatment. Left ventricular ejection fraction increased from 30% to 57%, and left ventricular end diastolic volume, end systolic volume, and end diastolic pressure showed striking reductions during treatment. Left ventricular mass decreased to about two thirds of the baseline value after treatment. Per cent wall thickening increased after carvedilol in the segments corresponding to non-compacted myocardium. A mismatch between 201Tl and BMIPP uptake in the area of non-compaction observed before carvedilol disappeared after treatment. Impaired sympathetic neuronal function shown by MIBG recovered after treatment. Thus carvedilol had beneficial effects on left ventricular function, hypertrophy, and both metabolic and adrenergic abnormalities in isolated left ventricular non-compaction.


Keywords: isolated left ventricular non-compaction; carvedilol; cardiac sympathetic nerve; ventricular remodelling

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Figure 1  .

Figure 1  

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(A) top: a short axial echocardiogram of the left ventricle at the mid-ventricular level before carvedilol treatment, showing an echogenic subendocardial layer—which corresponds to non-compacted myocardium—in the anterior, lateral, and inferior walls. ANT, anterior wall; LAT, lateral wall; INF, inferior wall; SEPT, septum; US, ultrasound. (A) bottom: short axial mid-ventricular images of cine magnetic resonance imaging at end diastole (ED) and end systole (ES) before (left half) and after (right half) carvedilol treatment. Wall motion and myocardial thickening improved after treatment. (B) Short axial mid-ventricular images of single photon emission computed tomography with MIBG, Tl, and BMIPP before (left half) and after (right half) carvedilol treatment. Top half: before treatment, the MIBG image 15 minutes after injection (early) shows nearly normal uptake, while four hours later (delayed) anterior, lateral, and inferior walls show apparently decreased uptake, indicating preserved sympathetic innervation but impaired intravesicular retention of MIBG; after treatment, the abnormally accelerated washout of MIBG disappeared. Bottom half: before carvedilol treatment the BMIPP image shows relatively decreased uptake at anterior, lateral, and inferior walls compared with myocardial perfusion on the Tl image; after treatment, the mismatch between Tl and BMIPP findings disappeared. BMIPP, β-methyliodophenyl pentadecanoic acid; MIBG, metaiodobenzylguanidine.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Chin T. K., Perloff J. K., Williams R. G., Jue K., Mohrmann R. Isolated noncompaction of left ventricular myocardium. A study of eight cases. Circulation. 1990 Aug;82(2):507–513. doi: 10.1161/01.cir.82.2.507. [DOI] [PubMed] [Google Scholar]
  2. Doughty R. N., Whalley G. A., Gamble G., MacMahon S., Sharpe N. Left ventricular remodeling with carvedilol in patients with congestive heart failure due to ischemic heart disease. Australia-New Zealand Heart Failure Research Collaborative Group. J Am Coll Cardiol. 1997 Apr;29(5):1060–1066. doi: 10.1016/s0735-1097(97)00012-0. [DOI] [PubMed] [Google Scholar]
  3. Fujimura M., Yasumura Y., Ishida Y., Nakatani S., Komamura K., Yamagishi M., Miyatake K. Improvement in left ventricular function in response to carvedilol is accompanied by attenuation of neurohumoral activation in patients with dilated cardiomyopathy. J Card Fail. 2000 Mar;6(1):3–10. doi: 10.1016/s1071-9164(00)80004-4. [DOI] [PubMed] [Google Scholar]
  4. Henderson E. B., Kahn J. K., Corbett J. R., Jansen D. E., Pippin J. J., Kulkarni P., Ugolini V., Akers M. S., Hansen C., Buja L. M. Abnormal I-123 metaiodobenzylguanidine myocardial washout and distribution may reflect myocardial adrenergic derangement in patients with congestive cardiomyopathy. Circulation. 1988 Nov;78(5 Pt 1):1192–1199. doi: 10.1161/01.cir.78.5.1192. [DOI] [PubMed] [Google Scholar]
  5. Junga G., Kneifel S., Von Smekal A., Steinert H., Bauersfeld U. Myocardial ischaemia in children with isolated ventricular non-compaction. Eur Heart J. 1999 Jun;20(12):910–916. doi: 10.1053/euhj.1998.1398. [DOI] [PubMed] [Google Scholar]
  6. Knapp F. F., Jr, Franken P., Kropp J. Cardiac SPECT with iodine-123-labeled fatty acids: evaluation of myocardial viability with BMIPP. J Nucl Med. 1995 Jun;36(6):1022–1030. [PubMed] [Google Scholar]
  7. Kramer C. M., Nicol P. D., Rogers W. J., Suzuki M. M., Shaffer A., Theobald T. M., Reichek N. Reduced sympathetic innervation underlies adjacent noninfarcted region dysfunction during left ventricular remodeling. J Am Coll Cardiol. 1997 Oct;30(4):1079–1085. doi: 10.1016/s0735-1097(97)00244-1. [DOI] [PubMed] [Google Scholar]
  8. Mitrani R. D., Klein L. S., Miles W. M., Hackett F. K., Burt R. W., Wellman H. N., Zipes D. P. Regional cardiac sympathetic denervation in patients with ventricular tachycardia in the absence of coronary artery disease. J Am Coll Cardiol. 1993 Nov 1;22(5):1344–1353. doi: 10.1016/0735-1097(93)90541-8. [DOI] [PubMed] [Google Scholar]
  9. Nakajo M., Shimabukuro K., Yoshimura H., Yonekura R., Nakabeppu Y., Tanoue P., Shinohara S. Iodine-131 metaiodobenzylguanidine intra- and extravesicular accumulation in the rat heart. J Nucl Med. 1986 Jan;27(1):84–89. [PubMed] [Google Scholar]
  10. Oechslin E. N., Attenhofer Jost C. H., Rojas J. R., Kaufmann P. A., Jenni R. Long-term follow-up of 34 adults with isolated left ventricular noncompaction: a distinct cardiomyopathy with poor prognosis. J Am Coll Cardiol. 2000 Aug;36(2):493–500. doi: 10.1016/s0735-1097(00)00755-5. [DOI] [PubMed] [Google Scholar]

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