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+A 51-year-old man was referred to our hospital due to severe congestive heart failure and ventricular arrhythmias in March 2008.
+He had been suffering from heart failure and ventricular tachycardia for years despite receiving the conventional treatment (ie, furosemide, lisinopril hydrate, pimobendan, warfarin potassium, carvedilol, metildigoxin and amiodarone hydrochloride).
+His height was 161 cm and body weight was 83 kg.
+Blood pressure was 110/60 mm Hg.
+The fasting blood glucose was 107 mg/dl and HbA1c was 6.3%.
+The chest x-ray showed cardiomegaly with a cardiothoracic ratio of 0.67 (figure 1A).
+ECG, as shown in video 1, revealed a diffused hypokinetic left ventricle with markedly dilated left ventricle dimension (end-diastole: 95 mm) and reduced EF (0.11).
+The coronary angiogram was normal.
+A myocardial biopsy revealed that over 50% of cardiomyocytes were replaced by fibrosis (figure 2).
+An implantable cardioverter-defibrillator was implanted.
+Due to the typical facial appearance and thickening of hands, he was referred to the endocrinology department.
+The plasma level of GH was 8.2 ng/ml and IGF-1 was 504 ng/ml.
+MRI demonstrated a macroadenoma in the pituitary.
+Thus, he was diagnosed as acromegaly.
+He was treated with octreotide long-acting-release (LAR) for 8 months.
+Thereafter, he underwent trans-sphenoidal surgery in January 2009 (figure 3).
+The plasma levels of GH and IGF-1 were decreased with octreotide LAR, but basal plasma levels of GH were always more than 4 ng/ml and plasma IGF-1 levels were above the appropriate age range (figure 3).
+After surgery, both plasma levels of GH and IGF-1 further decreased.
+Basal plasma levels of GH were mostly less than 0.5 ng/ml and IGF-1 levels were within normal ranges (figure 3).
+With the treatment of LAR, the cardiac function improved partially (cardiothoracic ratio=0.58; EF=0.20 in September 2008).
+After surgery, the cardiac function improved drastically (cardiothoracic ratio=0.47; EF=0.55 in April 2009; figures 1B and ​and2B).2B).
+Frequency of ventricular arrhythmias decreased and pimobendan was tapered off.