Inflammatory Cardiomyopathy Associated with Rheumatoid Arthritis Treated with Left Ventricular Assist Device

Cardiovascular involvement is common in patients with rheumatoid arthritis (RA), however, advanced heart failure is rare. We report a case of severe heart failure who required the placement of left ventricular assist device (LVAD). A 34-year old woman, who had been diagnosed as RA 8 years before and treated with predonisolone and methotrexate, was admitted to the local hospital due to short of breath. She had severe left ventricular (LV) dysfunction with an ejection fraction (EF) of 15%. Twenty days after the recovery by intensive treatment, she was re-hospitalized due to cardiogenic shock requiring intravenous administration of inotropes and intraaortic balloon pump (IABP). She was referred to our institution as a candidate of heart transplantation because she required the continuous infusions of high-dose inotropes. Fluorine-18 fluorodeoxyglucose positron emission tomography (18F-FDG PET) revealed increased uptake in LV. Histologic examination from right ventricle showed infiltration of CD3-T lymphocytes and diffuse interstitial or replacement myocardial fibrosis. Based on these finding, she was diagnosed as chronic inflammatory cardiomyopathy with little chance of LV recovery. On the other hand, RA was in a state of remission. She was judged as an indication for heart transplantation and underwent a successful placement of LVAD.