When the Heart Runs Out of Heartbeats

A 50-year-old man was referred to the Advanced Heart Failure clinic at our institution for consideration of additional treatment options. He was diagnosed with heart failure (HF) 4 years earlier. Transthoracic echocardiography revealed a dilated left ventricle (LV) with an LV end-diastolic dimension of 5.5 cm, globally depressed ejection fraction (EF; estimated at 30%), and moderate mitral regurgitation. Complete blood cell count, urinalysis, and liver function tests were normal. Screening for hemochromatosis, human immunodeficiency virus, rheumatologic disease, and amyloidosis was performed and was negative. He did not have a family history of cardiomyopathy or sudden cardiac death. Coronary angiography revealed no evidence of obstructive coronary artery disease. Right heart catheterization demonstrated a right atrial pressure of 15 mm Hg, pulmonary artery pressure of 41/21 mm Hg, pulmonary capillary wedge pressure of 20 mm Hg, and cardiac index of 2.3 L min 1 m 2