Rapid progression of left ventricular hypertrophy caused by leukaemic infiltration of myocardium.

Abstract

A man in his 40s was hospitalized due to recurrence of acute myeloid leukaemia. Echocardiography was performed because of negative T waves in the electrocardiogram. Severe and global left ventricular hypertrophy (LVH) was observed (Panels B and E, see Supplementary data online, Video S2), which was not found 15 months ago (Panels A and D, Supplementary data online, Video S1). Computed tomography scan also showed severe LVH (Panel H), which was not found 3 months ago (Panel G). Thus, it was confirmed that the rapid hypertrophic change occurred within 3 months. Low-dose Ara-C (cytosine arabinoside) and VP-16 (etoposide) therapy was administered for leukaemia. Echocardiography, after two weeks from the start of treatment, showed reduced LVH (Panels C and F). Therefore, the myocardial infiltration of leukaemia cells was considered as the cause of LVH. Unfortunately, 16 weeks later, the patient died by multiple organ failure. Autopsy showed that the cardiac wall thickened and numerous numbers of leukaemia cells infiltrated in the myocardium (Panels J and K). Distribution of the myocardial fibre was disarrayed but necrosis was not found. Infiltration of leukaemia cells was observed in multiple organs.