O54-2 - Super High Dose Beta-blocker Administration for the Patients with Dilated Cardiomyopathy

First case is a 25-year-old female with dilated cardiomyopathy. Left ventricular end-diastolic diameter (LVEDD) was 74 mm and ejection fraction (EF) was 29%. Carvedilol was already uptitrated to 20 mg twice daily. Right heart catheterization (RHC) revealed very low cardiac output (C.O. 2.82 l/min), cardiac index (C.I. 1.47 l/min/m2), stroke volume (SV 29 ml) and rapid heart rate (HR 96/min) despite maximum dosage of carvedilol in Japan. Carvedilol was uptitrated to 50 mg twice daily and additional 10 mg bisoprolol twice daily was started under administration of low-dose dobutamine. After complete uptitration of beta blockers and termination of dobutamine, RHC showed elevated C.O. (4.25 l/min), C.I. (2.25 l/min/m2), SV (52 ml) and decreased HR (82/min). After the initiation of super high dose beta-blocker therapy, she has no heart failure rehospitalization. Second case was 35-year-old male. He has a history of myocarditis following influenza viral infection 7 years before. LVEDD was 79 mm and EF was 21%. Carvedilol was 5 mg twice daily. To reduce HR (93/min at rest), carvedilol was uptitrated to 50 mg twice daily and additional bisoprolol 10 mg twice daily was introduced. LVEDD improved to 69 mm and EF increased to 27% after six months. Beta-blocker is a key drug for heart failure therapy. We should make every effort to maximize the dose of beta blocker as much as possible.