1
|
Lv L, Zhai M, Zhang P, Chen Y. Diagnosis of Loffler endocarditis by cardiac magnetic resonance imaging combined with echocardiography: A case report. Asian J Surg 2024; 47:2654-2655. [PMID: 38519315 DOI: 10.1016/j.asjsur.2024.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 03/01/2024] [Indexed: 03/24/2024] Open
Affiliation(s)
- Lili Lv
- The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, 730000, Gansu Province, China
| | - Manman Zhai
- The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, 730000, Gansu Province, China
| | - Pengwei Zhang
- The First Clinical Medical College of Gansu University of Chinese Medicine, Lanzhou, 730000, Gansu Province, China
| | - Yongqing Chen
- Department of Cardiovascular Medicine, Gansu Central Hospital, No. 999, Mogao Avenue, Anning District, Lanzhou, 730000, Gansu Province, China.
| |
Collapse
|
2
|
Su S, Liang L, Lü L, Li M, Zhang X, Jin Y, Wei W, Wan Z. In-Depth Review of Loeffler Endocarditis: What Have We Learned? J Inflamm Res 2024; 17:1957-1969. [PMID: 38562658 PMCID: PMC10984210 DOI: 10.2147/jir.s458692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/19/2024] [Indexed: 04/04/2024] Open
Abstract
Loeffler endocarditis, eosinophilic endocarditis or eosinophilic endomyocardial disease are conditions associated with hypereosinophilia and they affect the heart function. Loeffler endocarditis is a rare endomyocardial disorder thought to be caused by eosinophilic damage. The disorder is characterized by inflammatory infiltration, formation of thrombus within cardiovascular system, and ultimately fibrosis of the afflicted area. It can lead to multiple severe complications, including thromboembolic disease, thickening of fibrous tissue in the endocardium of ventricles, valve involvement, apical obliteration, and various heart disorders. Although early clinical intervention can lead to remission, the underlying mechanisms of the disorder remain unresolved. In the present article, we summarise the existing literature concerning Loeffler endocarditis based on PubMed, Web of Science, and other medical databases to conduct an in-depth review of the epidemiology, etiology, pathophysiological mechanisms, staging, diagnosis, treatment and prognosis of Loeffler endocarditis. Meanwhile, we provide novel patients data and clinical figures of Loeffler endocarditis to supplement the understanding of this cardiac disorder. The findings presented in this article provide a basis for further studies and can be used to improve management of the disorder.
Collapse
Affiliation(s)
- Shitong Su
- Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China
- Division of Head & Neck Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Lianjing Liang
- Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Lin Lü
- Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Mingfeng Li
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Xiaoling Zhang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Yongmei Jin
- Department of Laboratory Medicine, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Wei Wei
- Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China
| | - Zhi Wan
- Rare Diseases Center, West China Hospital, Sichuan University, Chengdu, 610041, People’s Republic of China
| |
Collapse
|
3
|
Hypereosinophilia and Löffler's Endocarditis: A Systematic Review. AMERICAN JOURNAL OF MEDICAL CASE REPORTS 2021; 9:241-248. [PMID: 33732873 PMCID: PMC7963396 DOI: 10.12691/ajmcr-9-4-10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Löffler endocarditis is an uncommon, but known complication of hypereosinophilic syndrome (HES). It is a relatively rare entity, and remains poorly understood. To this point in time, the compendium of knowledge about this disease consists of various case reports, prospective studies and review articles. We aim to present a scoping study about this disease. Our goals are to identify the characteristic features found in case reports to identify characteristic features found in patients with Löffler endocarditis as a result of hypereosinophilic syndrome. An analysis of the 26 case reports showed a mean age of 41.6 years with a standard deviation of 17.1 years. Dyspnea was the most common presenting complaint (64%) followed by fatigue (23%), cough (19%), fever (19%), orthopnea/paroxysmal nocturnal dyspnea (19%), stroke related symptoms (15%), chest pain (15%) and lower extremity edema (15%). The most common cardiac structure affected was the mitral valve (65%), followed by the tricuspid valve (42%), left ventricle (23%), with 35% of cases having involvement of two valves. The most common therapeutic modality was immunosuppression (85%), followed by anticoagulation (73%) and mitral valve replacement (23%). Death was reported in 19% of the cases. Löffler's endocarditis continues to be associated with high morbidity and mortality. Further research must aim to develop guidelines for management of this uncommon manifestation of hypereosinophilic syndrome.
Collapse
|
4
|
Metze M, Davierwala PM, Andreas H, Klingel K, Laufs U, Klöter T. Progression of left ventricular thrombus in Loeffler's endocarditis without eosinophilia-case report and review of the literature. Clin Res Cardiol 2019; 108:1163-1170. [PMID: 31089810 DOI: 10.1007/s00392-019-01483-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 04/23/2019] [Indexed: 02/07/2023]
Affiliation(s)
- Michael Metze
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
| | - Piroze M Davierwala
- Universitätsklinik für Herzchirurgie, Herzzentrum Leipzig, Strümpellstrasse 38, 04289, Leipzig, Germany
| | - Hagendorff Andreas
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Karin Klingel
- Kardiopathologie, Institut für Pathologie und Neuropathologie, Universitätsklinikum Tübingen, Liebermeisterstr. 8, 72076, Tübingen, Germany
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Tristan Klöter
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| |
Collapse
|
5
|
Kim DS, Lee S, Choi CW. Loeffler endocarditis in chronic eosinophilic leukemia with FIP1L1/PDGFRA rearrangement: full recovery with low dose imatinib. Korean J Intern Med 2018; 33. [PMID: 28651427 PMCID: PMC5943649 DOI: 10.3904/kjim.2016.100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Dae Sik Kim
- Division of Oncology and Hematology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Sunki Lee
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Chul Won Choi
- Division of Oncology and Hematology, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
- Correspondence to Chul Won Choi, M.D. Division of Oncology and Hematology, Department of Internal Medicine, Korea University Guro Hospital, 148 Gurodong-ro, Gurogu, Seoul 08308, Korea Tel: +82-2-2626-3058 Fax: +82-2-862-6453 E-mail:
| |
Collapse
|
6
|
Hypereosinophilic Syndrome: A Case of Fatal Löffler Endocarditis. Case Rep Cardiol 2016; 2016:2359532. [PMID: 26904305 PMCID: PMC4745824 DOI: 10.1155/2016/2359532] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 01/06/2016] [Indexed: 11/18/2022] Open
Abstract
Hypereosinophilic syndrome (HES) is a rare disorder with unknown global prevalence, barely reported in Hispanic population, and characterized by persistent eosinophilia in association with organ dysfunctions directly attributable to eosinophilic infiltration. Cardiac involvement may be present in 50 to 60% of the patients. This is known as Löffler endocarditis. We present a case of a 36-year-old Hispanic man with signs of heart failure. Laboratory studies showed eosinophilia (23,100/μL). Thoracic computer tomography showed bilateral pleural effusion and a large left ventricular mass. Transthoracic echocardiography showed left ventricle apical obliteration and a restrictive pattern. Pulmonary angiography demonstrated a thrombus in the lingular and middle lobe. Despite treatment, the patient deceased seven days after admission. Autopsy confirmed the diagnosis of Löffler endocarditis.
Collapse
|
7
|
Sarangi S, Phillips SD, Burkhart HM. Strongyloides-associated left ventricular thrombus. Ann Thorac Surg 2013; 96:1487. [PMID: 24088474 DOI: 10.1016/j.athoracsur.2013.01.089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 01/21/2013] [Accepted: 01/28/2013] [Indexed: 11/16/2022]
Affiliation(s)
- Siddharth Sarangi
- Department of Surgery, Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Sabrina D Phillips
- Department of Internal Medicine, Division of Cardiology, Mayo Clinic, Rochester, Minnesota
| | - Harold M Burkhart
- Department of Surgery, Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota.
| |
Collapse
|
8
|
Loeffler's endocarditis caused by Strongyloides infection. Int J Cardiol 2013; 164:e19-21. [PMID: 23079090 DOI: 10.1016/j.ijcard.2012.09.141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Accepted: 09/22/2012] [Indexed: 11/22/2022]
|
9
|
Mortality in hypereosinophilic syndrome: 19 years of experience at Mayo Clinic with a review of the literature. Leuk Res 2013; 37:392-5. [DOI: 10.1016/j.leukres.2012.12.016] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 12/15/2012] [Accepted: 12/22/2012] [Indexed: 01/21/2023]
|
10
|
Ordovas KG, Higgins CB. Delayed contrast enhancement on MR images of myocardium: past, present, future. Radiology 2011; 261:358-74. [PMID: 22012903 DOI: 10.1148/radiol.11091882] [Citation(s) in RCA: 153] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Differential enhancement of myocardial infarction was first recognized on computed tomographic (CT) images obtained with iodinated contrast material in the late 1970s. Gadolinium enhancement of myocardial infarction was initially reported for T1-weighted magnetic resonance (MR) imaging in 1984. The introduction of an inversion-recovery gradient-echo MR sequence for accentuation of the contrast between normal and necrotic myocardium was the impetus for widespread clinical use for demonstrating the extent of myocardial infarction. This sequence has been called delayed-enhancement MR and MR viability imaging. The physiologic basis for differential enhancement of myocardial necrosis is the greater distribution volume of injured myocardium compared with that of normal myocardium. It is now recognized that delayed enhancement occurs in both acute and chronic (scar) infarctions and in an array of other myocardial processes that cause myocardial necrosis, infiltration, or fibrosis. These include myocarditis, hypertrophic cardiomyopathy, amyloidosis, sarcoidosis, and other myocardial conditions. In several of these diseases, the presence and extent of delayed enhancement has prognostic implications. Future applications of delayed enhancement with development of MR imaging and CT techniques will be discussed.
Collapse
Affiliation(s)
- Karen G Ordovas
- Department of Radiology, UCSF Medical Center, 505 Parnassus Ave, Room L308, Box 0628, San Francisco, CA 94143-0628, USA
| | | |
Collapse
|
11
|
Gurgun A, Tuluce K, Tuluce SY, Gurgun C, Bayraktaroglu S, Tombuloglu M, Cinar CS. Hypereosinophilic syndrome presenting with large left ventricular apical thrombus and pulmonary embolism. Echocardiography 2011; 28:E180-2. [PMID: 21854430 DOI: 10.1111/j.1540-8175.2011.01479.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A 45-year-old man presented with dyspnea on exertion, fatigue, and cough. Transthoracic echocardiography showed a large apical thrombus in the left ventricle. The laboratory results showed prominent eosinophilia on blood smear, elevated acute phase reactants and D-dimer serum levels. Bone marrow examination showed a Fip1-like platelet-derived growth factor receptor alfa fusion gene mutation. The case was diagnosed as myeloproliferative variant hypereosinophilic syndrome. Contrast-enhanced computed tomography demonstrated thrombi not only in left ventricle but also in multiple segmental pulmonary arteries. Cardiac magnetic resonance imaging showed left ventricular apical thrombus without subendocardial fibrosis. Cardiopulmonary manifestations of hypereosinophilic syndrome completely resolved after treatment.
Collapse
Affiliation(s)
- Alev Gurgun
- Department of Chest Diseases, Ege University Faculty of Medicine, Izmir, Turkey
| | | | | | | | | | | | | |
Collapse
|
12
|
Rezaizadeh H, Sanchez-Ross M, Kaluski E, Klapholz M, Haider B, Gerula C. Acute eosinophilic myocarditis: diagnosis and treatment. ACTA ACUST UNITED AC 2010; 12:31-6. [PMID: 20201659 DOI: 10.3109/17482940903578998] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Hypereosinophilic syndrome (HES) is a rare disorder of unregulated eosinophilia, which if untreated, may lead to systemic tissue infiltration and inflammation. Cardiac involvement is a common and serious associated complication. We describe a case of HES associated myocarditis mimicking a non-ST elevation MI (NSTEMI). Unlike myocarditis in general, our patient responded well to high dose methylprednisone, the standard of care in HES. We review the clinical presentation, pathophysiology, pathology and treatment of eosinophilic myocarditis related to HES.
Collapse
|
13
|
Václavík J, Szotkowski T, Hutyra M, Kozák J, Lukl J, Táborský M. Development of Löffler's endocarditis in FIP1L1-PDGFRalpha-positive hypereosinophilic syndrome despite continuous imatinib mesylate therapy and continuous complete remission. Am J Hematol 2010; 85:296-9. [PMID: 20169542 DOI: 10.1002/ajh.21635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
14
|
Paydar A, Ordovas KG, Reddy GP. Magnetic resonance imaging for endomyocardial fibrosis. Pediatr Cardiol 2008; 29:1004-5. [PMID: 18043857 DOI: 10.1007/s00246-007-9151-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2007] [Revised: 09/10/2007] [Accepted: 10/26/2007] [Indexed: 11/30/2022]
Abstract
Magnetic resonance images (MRI) of a pediatric patient with endomyocardial fibrosis secondary to idiopathic hypereosinophilic syndrome are presented. Previously reported in adults, MRI findings of endomyocardial fibrosis in this case include right ventricular diastolic dysfunction, mild systolic dysfunction and extensive subendocardial delayed contrast enhancement. Right atrial enlargement and organized right ventricular thrombus are also demonstrated.
Collapse
Affiliation(s)
- Amir Paydar
- Department of Radiology, University of California San Francisco, Suite M396, Box 0628, San Francisco, CA 94143-0628, USA
| | | | | |
Collapse
|
15
|
Yoon HJ, Kim H, Park HS, Cho YK, Nam CW, Han SW, Hur SH, Kim YN, Kim KB. Loeffler's Endocarditis due to Idiopathic Hypereosinophilic Syndrome. J Cardiovasc Ultrasound 2008. [DOI: 10.4250/jcu.2008.16.4.136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Hyuck-Jun Yoon
- Division of Cardiology, Department of Internal Medicine, Dongsan Medical Center, Keimyung University, Daegu, Korea
| | - Hyungseop Kim
- Division of Cardiology, Department of Internal Medicine, Dongsan Medical Center, Keimyung University, Daegu, Korea
| | - Hyoung-Seob Park
- Division of Cardiology, Department of Internal Medicine, Dongsan Medical Center, Keimyung University, Daegu, Korea
| | - Yun-Kyeong Cho
- Division of Cardiology, Department of Internal Medicine, Dongsan Medical Center, Keimyung University, Daegu, Korea
| | - Chang-Wook Nam
- Division of Cardiology, Department of Internal Medicine, Dongsan Medical Center, Keimyung University, Daegu, Korea
| | - Seong-Wook Han
- Division of Cardiology, Department of Internal Medicine, Dongsan Medical Center, Keimyung University, Daegu, Korea
| | - Seung-Ho Hur
- Division of Cardiology, Department of Internal Medicine, Dongsan Medical Center, Keimyung University, Daegu, Korea
| | - Yoon-Nyun Kim
- Division of Cardiology, Department of Internal Medicine, Dongsan Medical Center, Keimyung University, Daegu, Korea
| | - Kwon-Bae Kim
- Division of Cardiology, Department of Internal Medicine, Dongsan Medical Center, Keimyung University, Daegu, Korea
| |
Collapse
|