断酒により心機能および心筋組織所見が改善したアルコール性心筋症の1例

A Case of Alcoholic Cardiomyopathy with Improved in Cardiac Functions and Histologic Findings Brought about by Abstention from Alcohol

　36歳，男性．日本酒1日5合，10年間の飲酒歴あり．下腿浮腫と起坐呼吸が増悪し当科受診した。心胸郭比は71％，左室駆出分画は24％と低下，左房・左室径は拡大し，拡張型心筋症の疑いで入院した．心係数は3.46／分／m²，肺動脈楔入圧と肺動脈圧はそれぞれ22，40／24 mmHgと上昇していた．左室造影では壁運動は全体的に低下していた．冠動脈造影は左右ともに正常であり，心筋組織所見では心筋線維の軽度肥大と単線維性脱落，間質の浮腫，結合織の軽度の増生を認めた．強心配糖体と利尿剤で症状は改善し，退院後，2年間の断酒をさせたところ，1年後で心胸郭比は46％，左室駆出分画は74％，2年後で心係数は4.8／分／m²，肺動脈楔入圧は14 mmHgと心血行動態改善の他，心筋組織所見も改善した．本例のように心エコー図所見を中心とした臨床経過とともに心筋組織所見を経時的に検討した報告は極めて少なく文献的考察を加えて報告する．

A 36-year-old male was admitted to hospital in February 1993 because of increasing dyspnea and orth-opnea. He had a history of heavy alcoholic intake for 10 years with a 125 ml of daily ethanol consumption, but he had no history of hypertension. The chest X-ray film presented pulmonary congestion and cardiomegaly with a cardiothoracic ratio of 0.71. The echocardiogram showed atrioventricular regurgitations, left atrial and ventricular dilatations with an ejection fraction of 24%. The hemodynamic data revealed post-capillary pulmo-nary hypertension (pulmonary artery pressure 40/24 mmHg, pulmonary capillary wedge pressure 22 mmHg, cardiac index 3.46/min/m²). The left ventriculogram showed generally reduced wall motion. The coronary arteriogram presented normal findings. Endomyocardial biopsy of right ventricle showed a few dropouts of mildly hypertrophic myocardial fibers, interstitial edema with mononuclear cell infiltration, and mild inter-stitial fibrosis. He was discharged in March 1993 on a regimen of digoxin, 0.25 mg/day ; furosemide, 60 mg/ day. He did not drink alcohol for the next 2 years. His cardiothoracic ratio improved to 0.56, and normalized ventricular dimension and the almost complete dis-appearance of the interstitial edema were observed two months later. One year later, his cardiothoracic ratio and ejection fraction were 0.46 and 74%, respectively. The regression of atrial dilatation and the disappear-ance of atrioventricular regurgitation were also obser-ved on the echocardiogram. Two years later, mild car-diac hypertrophy remained on both the echocardiogram and the histological findings despite the normalized hemodynamic data. Therefore, it is emphasized that a patient with alcoholic cardiomyopathy needs to subse-quently abstain from alcohol despite normalization in-dicated by their chest roentgenogram and hemodynamic data.