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Scatularo CE, Posada Martínez EL, Alba AC, Renedo MF, N Llober M, Elfman M, Pérez de Arenaza D, Diez M, Saldarriaga C, Cingolani E, Sosa Liprandi MI. Endomyocardiofibrosis in the Americas Collaborative Study: The EMF-SIAC Registry. Curr Probl Cardiol 2023; 48:101995. [PMID: 37516331 DOI: 10.1016/j.cpcardiol.2023.101995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 07/19/2023] [Indexed: 07/31/2023]
Abstract
Endomyocardiofibrosis (EMF) is a restrictive cardiomyopathy characterized by subendocardial fibrosis due to eosinophilic myocardial infiltration. EMF may commonly present with heart failure (HF) or atrial fibrillation (AF). Immunosuppression can be effective in early stages, but not in the chronic phase. Our objective was to describe the characteristics of EMF patients in the Americas. This registry is a retrospective multicenter cross-sectional study including patients ≥18 years-old with EMF diagnosed by imaging methods, according to the Mocumbi criteria. Clinical, biochemical, and imaging variables were analyzed. On the 54 patients included, 28 (52%) were male with an age of 47 years. The etiology was idiopathic in 47 (87%) patients, familial in 4 (7%), and secondary to chemotherapy in 2 (3.5%). We detected a history of HF in 41 patients (76%), AF in 19 (35%), and ischemic stroke in 8 (15%). The diagnosis was made by echocardiography in all patients, and 38% had Cardiac Resonance or Computed Tomography. Thirty-five patients (65%) presented a left ventricular ejection fraction ≥50%, 11 (21%) severe mitral regurgitation, and 18 (33%) severe tricuspid regurgitation. In 17 patients (32%) the diagnosis was confirmed by endomyocardial biopsy. Among medical therapy, 72% received beta-blockers, 63% vasodilators, 65% mineralocorticoid antagonists, 7.4% SGLT2 inhibitors, and 11% corticosteroids. Subendocardial resection was performed in 9 (16%) patients and mitral valve replacement in 11 (20%) patients. In conclusion, EMF patients had a high prevalence of HF, AF, and embolic events. The diagnosis was frequently made in an advanced stage when HF management and surgery were the only effective treatments.
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Affiliation(s)
- Cristhian E Scatularo
- Department of cardiology, Sanatorio de la Trinidad de Palermo, Buenos Aires, Argentina.
| | | | - Ana C Alba
- Department of Cardiology, University Health Network, Toronto, Ontario, Canada
| | - María F Renedo
- Department of Heart Failure and Thoracic Transplantation, Fundacion Favaloro, Buenos Aires, Argentina
| | - Mariano N Llober
- Department of Cardiology, Hospital Argerich, Buenos Aires, Argentina
| | - Melisa Elfman
- Department of Heart failure, Sanatorio Güemes, Buenos Aires, Argentina
| | - Diego Pérez de Arenaza
- Department of Cardiovascular Imaging, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Mirta Diez
- Department of Heart Failure, Pulmonary Hypertension and Heart Transplantation, Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | - Clara Saldarriaga
- Department of Heart Failure, CardioVID Clinic, Medellin, Antioquia, Colombia
| | - Eugenio Cingolani
- Department of electrophysiology, Cedears-Sinai Medical Center, Los Angeles, California, United States
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Sliwa K, Viljoen CA, Hasan B, Ntusi NAB. Nutritional Heart Disease and Cardiomyopathies: JACC Focus Seminar 4/4. J Am Coll Cardiol 2022; 81:S0735-1097(22)07308-9. [PMID: 36599756 DOI: 10.1016/j.jacc.2022.08.812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 08/24/2022] [Indexed: 01/03/2023]
Abstract
This JACC Focus Seminar provides an overview of and highlights recently published research on cardiomyopathies and nutritional heart disease that have a higher prevalence in tropical regions. The development of tropical cardiomyopathies and nutritional cardiovascular disease (CVD) is complicated by high rates of poverty, fragmented health care systems, and suboptimal access to health care because of socioeconomic inequalities, leading to the fact that children, adolescents, and young adults are disproportionally affected. Such tropical cardiomyopathies and nutritional CVD that have not been prevalent in high-income countries in the past decades are now reemerging. When treating migrants or refugees, it is important for attending physicians to consider the burden of endemic diseases in the countries of origin and the likelihood that such patients might be affected. In this review, the authors propose an approach for adequate diagnostic work-up leading to appropriate care for those with suspected or confirmed tropical cardiomyopathies and nutritional CVD.
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Affiliation(s)
- Karen Sliwa
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
| | - Charle Andre Viljoen
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Babar Hasan
- Division of Cardio-Thoracic Sciences, Sindh Institute of Urology and Transplant, Karachi, Pakistan
| | - Ntobeko A B Ntusi
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; Division of Cardiology, Department of Medicine, Groote Schuur Hospital, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa; South African Medical Research Council Extramural Unit on Intersection of Noncommunicable Diseases and Infectious Diseases, Cape Town, South Africa
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Minja NW, Nakagaayi D, Aliku T, Zhang W, Ssinabulya I, Nabaale J, Amutuhaire W, de Loizaga SR, Ndagire E, Rwebembera J, Okello E, Kayima J. Cardiovascular diseases in Africa in the twenty-first century: Gaps and priorities going forward. Front Cardiovasc Med 2022; 9:1008335. [PMID: 36440012 PMCID: PMC9686438 DOI: 10.3389/fcvm.2022.1008335] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022] Open
Abstract
In 2015, the United Nations set important targets to reduce premature cardiovascular disease (CVD) deaths by 33% by 2030. Africa disproportionately bears the brunt of CVD burden and has one of the highest risks of dying from non-communicable diseases (NCDs) worldwide. There is currently an epidemiological transition on the continent, where NCDs is projected to outpace communicable diseases within the current decade. Unchecked increases in CVD risk factors have contributed to the growing burden of three major CVDs-hypertension, cardiomyopathies, and atherosclerotic diseases- leading to devastating rates of stroke and heart failure. The highest age standardized disability-adjusted life years (DALYs) due to hypertensive heart disease (HHD) were recorded in Africa. The contributory causes of heart failure are changing-whilst HHD and cardiomyopathies still dominate, ischemic heart disease is rapidly becoming a significant contributor, whilst rheumatic heart disease (RHD) has shown a gradual decline. In a continent where health systems are traditionally geared toward addressing communicable diseases, several gaps exist to adequately meet the growing demand imposed by CVDs. Among these, high-quality research to inform interventions, underfunded health systems with high out-of-pocket costs, limited accessibility and affordability of essential medicines, CVD preventive services, and skill shortages. Overall, the African continent progress toward a third reduction in premature mortality come 2030 is lagging behind. More can be done in the arena of effective policy implementation for risk factor reduction and CVD prevention, increasing health financing and focusing on strengthening primary health care services for prevention and treatment of CVDs, whilst ensuring availability and affordability of quality medicines. Further, investing in systematic country data collection and research outputs will improve the accuracy of the burden of disease data and inform policy adoption on interventions. This review summarizes the current CVD burden, important gaps in cardiovascular medicine in Africa, and further highlights priority areas where efforts could be intensified in the next decade with potential to improve the current rate of progress toward achieving a 33% reduction in CVD mortality.
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Affiliation(s)
- Neema W. Minja
- Rheumatic Heart Disease Research Collaborative, Uganda Heart Institute, Kampala, Uganda
- Kilimanjaro Clinical Research Institute (KCRI), Moshi, Tanzania
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Doreen Nakagaayi
- Department of Adult Cardiology, Uganda Heart Institute, Kampala, Uganda
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Twalib Aliku
- Department of Pediatric Cardiology, Uganda Heart Institute, Kampala, Uganda
| | - Wanzhu Zhang
- Department of Adult Cardiology, Uganda Heart Institute, Kampala, Uganda
| | - Isaac Ssinabulya
- Department of Adult Cardiology, Uganda Heart Institute, Kampala, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Juliet Nabaale
- Department of Adult Cardiology, Uganda Heart Institute, Kampala, Uganda
| | - Willington Amutuhaire
- Department of Medicine, Case Western Reserve University, Cleveland, OH, United States
| | - Sarah R. de Loizaga
- Heart Institute, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
- Department of Pediatrics, University of Cincinnati, Cincinnati, OH, United States
| | - Emma Ndagire
- Department of Pediatric Cardiology, Uganda Heart Institute, Kampala, Uganda
| | | | - Emmy Okello
- Department of Adult Cardiology, Uganda Heart Institute, Kampala, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - James Kayima
- Department of Adult Cardiology, Uganda Heart Institute, Kampala, Uganda
- Department of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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Matarneh AS, Hailan YMA, Abdul Karim S, Al Kuwari M, Dabdoob WA. Endomyocardial fibrosis in a non‐tropical patient who presented with chest pain mimicking ACS and left ventricular thrombus, case report. Clin Case Rep 2022; 10:e05021. [PMID: 35620258 PMCID: PMC9125399 DOI: 10.1002/ccr3.5021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 10/01/2021] [Accepted: 10/08/2021] [Indexed: 12/04/2022] Open
Abstract
Endomyocardial fibrosis (EMF) is a disease known to cause restrictive cardiomyopathy. It shows a high prevalence in tropical countries. Several triggering factors have been proposed. However, the pathogenesis is still a mystery. The disease is progressive, and the outcome is generally unfavorable. The most common symptom is heart failure. However, an atypical presentation may be expected. Our case presented with symptoms suggestive of ischemia and missed diagnosis initially as ischemic cardiomyopathy. This report aims to increase the attention and awareness of this disease. We present a case of a 53‐year‐old man referred to the emergency department for sudden chest pain, left‐sided and non‐radiating lasted for several minutes, awoke him from sleep with no associated symptoms. He is known to have Diabetes type‐2 and hypertension on oral therapy. Cardiac markers were within the normal limit. The patient was discharged home with an appointment at the cardiology outpatient clinic. Echocardiography was done and revealed mildly reduced left ventricular (LV) systolic function, Ejection Fraction of 46%, asymmetric LV hypertrophy affecting the apical segments with aneurysm, and calcified apical thrombus. CT coronary angiography was done with non‐significant Left Anterior Descending artery lesions and left ventricular hypertrophy affecting the apex with calcified apical thrombus. Further investigation by cardiac MRI revealed apical thrombus and late apical uptake suggesting Endomyocardial Fibrosis of possible eosinophilic etiology. The patient continued to have attacks of similar chest pain, for which stress cardiac MRI was done and was negative for ischemia. Another diagnostic workup was done, including hematological and serological tests such as Antinuclear Antibodies and Schistosoma Antibodies. The patient was kept on valsartan and Bisoprolol with oral anticoagulant (vitamin K antagonist) and Rosuvastatin. EMF may have a heterogeneous presentation and should be considered in a patient with calcific apical thrombus without previous history of cardiac problem, even in the non‐tropical region.
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Affiliation(s)
- Ahmad S. Matarneh
- Internal Medicine Department of Medical Education Hamad Medical Corporation (HMC) Doha Qatar
| | - Yousef M. Ali Hailan
- Internal Medicine Department of Medical Education Hamad Medical Corporation (HMC) Doha Qatar
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Aliku TO, Rwebembera J, Lubega S, Zhang W, Lugero C, Namuyonga J, Omagino JOO, Okello E, Lwabi PS. Trends in Annual Incidence Rates of Newly Diagnosed Endomyocardial Fibrosis Cases at the Uganda Heart Institute: A 14-Year Review. Front Cardiovasc Med 2022; 9:841346. [PMID: 35498040 PMCID: PMC9051226 DOI: 10.3389/fcvm.2022.841346] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/14/2022] [Indexed: 02/04/2023] Open
Abstract
BackgroundFirst described in Uganda over seven decades ago, Endomyocardial fibrosis (EMF) is a rare form of restrictive cardiomyopathy found in the tropics. EMF occurs mainly in two phenotypes; biventricular involvement and right ventricular (RV) form. Previously endemic in several countries, there are reports suggesting that the disease is on the decline.ObjectivesTo describe trends in annual incidence rates of newly diagnosed EMF cases at the Uganda Heart Institute (UHI).MethodsThis was a retrospective chart review of all newly diagnosed EMF cases at UHI from January 2007 to December 2020. Cases were divided into two groups A (2007–2013) and B (2014–2020).ResultsA total of 155 cases were diagnosed during the period (Group A, n = 124; Group B, n = 31). There were no significant differences between the two groups A and B regarding median age at diagnosis (14 vs. 12 years, p = 0.0940), gender (48.4% female vs. 35.5%, p = 0.1987), and EMF type (66.9% RV EMF vs. 71.0%, p = 0.6634), respectively. The presence of complications such as intracardiac thrombus (5.6 vs. 32.2%, p = 0.0002) and pericardial effusion (57.3% vs. 80.6, p = 0.0172) were more frequent in group B than A, respectively. Pulmonary hypertension (PHT) was predominantly seen in cases with biventricular EMF compared to those with RV EMF (26 vs. 3.8%, p = 0.0001). The number of new cases diagnosed per year remained largely stable in the period 2007–2011, ranging 14–21 per year, peaked in 2012 (26 new cases), and thereafter declined from 10 cases seen in 2013 to 1–5 cases seen per year in the period 2017–2020. Similarly, the annual incidence rates of new EMF diagnosis remained relatively stable in the period 2007–2012, ranging between 22.7 and 29.7 per 10,000 patients seen in the echo labs, and then dramatically declined after 2012 to range between 1.0 and 4.5 new cases per 10,000 patients in the period between 2017 and 2020.ConclusionThere has been a steady decline in the number of new cases of EMF seen at the UHI. However, there were no significant differences in the gender, age at diagnosis and EMF subtype of cases during the period under review. Complication rates were more frequent in the later cohort.
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Affiliation(s)
- Twalib Olega Aliku
- Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
- Uganda Christian University School of Medicine, Mukono, Uganda
- *Correspondence: Twalib Olega Aliku
| | | | - Sulaiman Lubega
- Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | - Wanzhu Zhang
- Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | - Charles Lugero
- Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
| | - Judith Namuyonga
- Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
- Makerere University College of Health Sciences, Kampala, Uganda
| | | | - Emmy Okello
- Uganda Heart Institute, Mulago Hospital Complex, Kampala, Uganda
- Makerere University College of Health Sciences, Kampala, Uganda
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Pasteur-Rousseau A, Odouard S, Souibri K, Sebag FA, Deux JF, Damy T. [Cardiac imaging in infiltrative cardiomyopathies. What cardiovascular imaging modalities to propose in hypertrophic cardiomyopathies ?]. Ann Cardiol Angeiol (Paris) 2022; 71:63-74. [PMID: 35184821 DOI: 10.1016/j.ancard.2022.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 01/21/2022] [Indexed: 12/13/2022]
Abstract
Infiltrative cardiomyopathies are abnormal accumulations or depositions of different substances in cardiac tissue leading to its dysfunction, first diastolic, then systolic. The different infiltrative cardiomyopathies are amyloidosis (both light chain amyloidosis and transthyretin amyloidosis variants), lysosomal and glycogen storage disorders (Fabry-Anderson disease), and iron overload (hemochromatosis and thalassemia associated with blood transfusions), as well as inflammatory diseases such as sarcoidosis. We also evoke hypereosinophilic syndrome associated with endomyocardial fibrosis. Echocardiography is the first essential step after interrogatory and clinical examination and may help the cardiologist as a screening tool. Cardiac MRI is the second fundamental step towards the diagnosis especially due to the late gadolinium enhancement and to the T1-mapping. Cardiac amyloidosis diagnosis also requires the use of nuclear imaging. Cardiac CT-Scan may be useful for estimating the amyloid load, identify potential cardiac thrombus and rule out associated coronaropathy.
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Affiliation(s)
- Adrien Pasteur-Rousseau
- Institut Cœur Paris Centre (ICPC). Clinique Turin (9 rue de Turin, 75008 Paris), Clinique du Parc Monceau (21 rue de Chazelles, 75017 Paris), Clinique Floréal (40 rue Floréal, 93170 Bagnolet), France.
| | - Shirley Odouard
- CHU Henri Mondor, 1 Rue Gustave Eiffel, 94000 Créteil, France.
| | - Karam Souibri
- Institut Cœur Paris Centre (ICPC), Clinique Turin, 75008, Paris.
| | - Frederic A Sebag
- Institut Mutualiste Montsouris, 42 Boulevard Jourdan, 75014, Paris, France.
| | - Jean-François Deux
- Hôpitaux Universitaires de Genève (HUG), Rue Gabrielle-Perret-Gentil 4, 1205 Genève, Suisse.
| | - Thibaud Damy
- CHU Henri Mondor, 1 Rue Gustave Eiffel, 94000 Créteil.
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Guidelines for Echocardiographic Diagnosis of Cardiomyopathy: Recommendations from Echocardiography Group of Ultrasound Medicine Branch in Chinese Medical Association, Echocardiography Committee of Cardiovascular Branch in Chinese Medical Association. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2022. [DOI: 10.37015/audt.2022.210021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Rana Y, Tummala R, Kim B, Misra D. Endomyocardial Fibrosis Found Incidentally on Cardiac Imaging. Cureus 2021; 13:e17186. [PMID: 34548983 PMCID: PMC8438648 DOI: 10.7759/cureus.17186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2021] [Indexed: 11/05/2022] Open
Abstract
Endomyocardial fibrosis (EMF) is a rare disease in the developed world characterized by the fibrosis of the endocardium in one or both of the ventricles causing restrictive-type cardiomyopathy. We present a case of a 47-year-old Chinese female with a past medical history of breast cancer treated in 2014 currently on tamoxifen therapy presented to the cardiology office for multiple presyncopal and syncopal events at rest. She was found to have apical hypertrophic cardiomyopathy (HCM) on echocardiogram. Subsequently, cardiac magnetic resonance imaging (cMRI) showed severe apical hypertrophy without left ventricular aneurysm, and evidence of small apical thrombus with subendocardial enhancement. There was no resolution of the left ventricular thrombus after a year-long course of therapeutic anticoagulation, a finding more consistent with EMF. Though the diagnosis of EMF initially depends on echocardiographic findings, cMRI is an essential imaging modality that allows clinicians to easily differentiate between potential diagnoses with the information that it provides. Early diagnosis, differentiation, and treatment for HCM are important for a good prognosis.
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Affiliation(s)
- Yesha Rana
- Department of Internal Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel Medical Center, New York City, USA
| | - Ramyashree Tummala
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel Medical Center, New York City, USA
| | - Bette Kim
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai West Hospital, New York City, USA
| | - Deepika Misra
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel Medical Center, New York City, USA
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Uygur B, Turkvatan Cansever A, Demir AR, Kahraman S, Guner A, Sahin AA, Topel C, Celik O, Yildiz M, Erturk M. Detection of a rare cause of pulmonary hypertension by multimodality imaging: Left ventricular endomyocardial fibrosis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:520-524. [PMID: 33719039 DOI: 10.1002/jcu.23003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/12/2021] [Accepted: 02/28/2021] [Indexed: 06/12/2023]
Abstract
Endomyocardial fibrosis (EMF), a restrictive cardiomyopathy characterized by subendocardial fibrosis, is commonly seen in tropical and subtropical regions. EMF involving the left ventricle presents with severe pulmonary hypertension (PH) and is a rare cause of PH in non-tropical areas. Multimodality imaging is important for accurate diagnosis, especially cardiac magnetic resonance imaging which is the cornerstone. Herein, we report the case of a patient who presented with heart failure symptoms and severe PH, and in whom EMF was diagnosed by multimodality imaging.
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Affiliation(s)
- Begum Uygur
- Cardiology Department, University of Health Sciences Turkey Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Aysel Turkvatan Cansever
- Radiology Department, University of Health Sciences Turkey Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ali Riza Demir
- Cardiology Department, University of Health Sciences Turkey Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Serkan Kahraman
- Cardiology Department, University of Health Sciences Turkey Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Guner
- Cardiology Department, University of Health Sciences Turkey Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Anil Sahin
- Cardiology Department, University of Health Sciences Turkey Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Cagdas Topel
- Radiology Department, University of Health Sciences Turkey Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Omer Celik
- Cardiology Department, University of Health Sciences Turkey Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mustafa Yildiz
- Cardiology Department, University of Health Sciences Turkey Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Erturk
- Cardiology Department, University of Health Sciences Turkey Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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Neglected cardiovascular diseases and their significance in the Global North. Herz 2021; 46:129-137. [PMID: 33506326 DOI: 10.1007/s00059-021-05020-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 10/22/2022]
Abstract
Due to increasing global migration, the spectrum of cardiovascular disease (CVD) is changing in developed countries. Up to 3% of migrants arriving in Europe have underlying CVD. Despite their high global prevalence, conditions such as rheumatic heart disease, Chagas disease, endomyocardial fibrosis, tuberculous pericarditis, peripartum cardiomyopathy, and pulmonary hypertension are often under-recognized, and, as a result, neglected in industrialized countries. Many of these conditions, and their causes, are often unfamiliar to the health-care providers in host countries. In this review, we summarize the epidemiology, etiology, clinical presentation, diagnostic work-up, and management of neglected CVDs that have an increasing prevalence in the Global North.
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Scatularo CE, Posada Martínez EL, Saldarriaga C, Ballesteros OA, Baranchuk A, Sosa Liprandi A, Wyss F, Sosa Liprandi MI. Endomyocardiofibrosis: A Systematic Review. Curr Probl Cardiol 2020; 46:100784. [PMID: 33418479 DOI: 10.1016/j.cpcardiol.2020.100784] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 12/19/2020] [Indexed: 01/08/2023]
Abstract
Endomyocardiofibrosis was described first time in Uganda as an infrequent restrictive cardiomyopathy with a poor prognosis, characterized by fibrosis of the ventricular subendocardium and severe restrictive physiology leading to difficult therapeutic management and frequently associated with hypereosinophilic syndrome. Its higher prevalence in the tropics and its relationship in some cases with hypereosinophilic endocarditis has led to the search for genetic, infectious, autoimmune and nutritional causes, but its etiology remains unclear. It is a rare cardiomyopathy, difficult to diagnose and with a nonexistent effective treatment. Imaging methods such as echocardiography and cardiac magnetic resonance are essential for the initial diagnosis, although endomyocardial biopsy establishes the definitive diagnosis. Immunosuppressive treatment is only useful in the early stages of the disease and usually ineffective if installed late when signs of heart failure are present. Surgical treatment is generally palliative.
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Affiliation(s)
| | | | - Clara Saldarriaga
- Department of Cardiology and Heart Failure Clinic, Cardiovascular Clinic Santa Maria, University of Antioquia, Medellín, Colombia
| | | | - Adrian Baranchuk
- Division of Cardiology, Kingston Health Science Center, Queen's University, Kingston, Ontario, Canada
| | | | - Fernando Wyss
- Cardiovascular Services and Technology of Guatemala - Cardiosolutions, Guatemala City, Guatemala
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Gonzalez-Bartol E, Cecconi A, Diez-Villanueva P, Olivera MJ, Jimenez-Borreguero LJ, Alfonso F. T1 mapping in the assessment of endomyocardial fibrosis. Int J Cardiovasc Imaging 2020; 37:267-268. [PMID: 32767024 DOI: 10.1007/s10554-020-01955-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 07/23/2020] [Indexed: 10/23/2022]
Affiliation(s)
| | | | | | | | - Luis Jesus Jimenez-Borreguero
- Department of Cardiology, University Hospital La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), CIBER-CV, Autónoma University, Madrid, Diego de León, 62, 28006, Madrid, Spain
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Théry G, Faroux L, Deleuze P, Metz D. Idiopathic endomyocardial fibrosis in a Western European: a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2020; 4:1-5. [PMID: 32617477 PMCID: PMC7319822 DOI: 10.1093/ehjcr/ytaa104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 01/22/2020] [Accepted: 04/09/2020] [Indexed: 11/14/2022]
Abstract
Background Endomyocardial fibrosis (EMF) is a rare cause of restrictive cardiomyopathy, mainly found in tropical/subtropical country. Endomyocardial fibrosis causes severe congestive symptoms and may lead to end-stage heart failure. Case summary A French Caucasian 44-year-old man without noticeable medical history and who had never travelled outside of France was hospitalized for a first episode of acute heart failure revealing an atypical appearance of the left ventricle. Cardiac magnetic resonance (CMR) identified EMF, but investigations did not identify any aetiology (no eosinophilia). Despite optimal management of chronic heart failure, functional class declined rapidly resulting in several hospitalizations for heart failure. The patient finally underwent an elective heart transplantation with good results at 6-month follow-up. Discussion Endomyocardial fibrosis exact physiopathology remains unclear, although association with eosinophilia has been reported. Diagnosis is challenging and is based on multi-modal imagery with a central role of CMR. There is no consensus on optimal management, medical therapy having poor outcomes and rate of peri-operative complications being high. Heart transplantation should be considered for eligible patients.
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Affiliation(s)
- Guillaume Théry
- Cardiology Department, Reims University Hospital, Avenue du Général Koenig, 51092 Reims, France
| | - Laurent Faroux
- Cardiology Department, Reims University Hospital, Avenue du Général Koenig, 51092 Reims, France
| | - Philippe Deleuze
- Cardiac Surgery Department, Marie-Lannelongue Hospital, 133 Avenue de la Résistance, 92350 Le Plessis-Robinson, France
| | - Damien Metz
- Cardiology Department, Reims University Hospital, Avenue du Général Koenig, 51092 Reims, France
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14
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Nunnery S, Bottinor W, Das S. Cardiac Masses in a Patient With Pancreatic Adenocarcinoma and a History of Breast Carcinoma. JAMA Oncol 2020; 6:917-918. [PMID: 32324203 DOI: 10.1001/jamaoncol.2020.0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Sara Nunnery
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Wendy Bottinor
- Division of Cardiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Satya Das
- Division of Hematology and Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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15
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Sutter JS, Suboc TM, Rao AK. Tropical Endomyocardial Fibrosis. JACC Case Rep 2020; 2:819-822. [PMID: 34317354 PMCID: PMC8301721 DOI: 10.1016/j.jaccas.2020.02.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 02/27/2020] [Indexed: 11/28/2022]
Abstract
Tropical endomyocardial fibrosis is a common cause of restrictive cardiomyopathy worldwide, but is relatively rare in developed countries. We present a case of tropical endomyocardial fibrosis with right ventricular involvement initially mistaken as Ebstein’s anomaly. We highlight the need for timely and accurate diagnosis to ensure appropriate management. (Level of Difficulty: Intermediate.)
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Affiliation(s)
- Joanne S. Sutter
- Address for correspondence: Dr. Joanne S. Sutter, Rush University Medical Center, 1717 West Congress Parkway, Kellogg Suite 320, Chicago, Illinois 60612.
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16
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de Carvalho FP, Azevedo CF. Comprehensive Assessment of Endomyocardial Fibrosis with Cardiac MRI: Morphology, Function, and Tissue Characterization. Radiographics 2020; 40:336-353. [PMID: 32004118 DOI: 10.1148/rg.2020190148] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Endomyocardial fibrosis (EMF) affects approximately 12 million persons worldwide and is an important cause of restrictive cardiomyopathy in the developing world, with the highest prevalence reported in sub-Saharan Africa, South Asia, and South America. EMF is characterized by apical filling with fibrotic tissue of one or both ventricles, often associated with thrombus, calcification, and atrioventricular valve regurgitation, leading to typical symptoms of restrictive heart failure. Transthoracic echocardiography (TTE) is the first-line modality for assessment of EMF, basically owing to its widespread availability. However, in recent years cardiac MRI has emerged as a powerful tool for assessment of cardiac morphology and function, with higher accuracy than TTE, along with the unique advantage of being able to provide comprehensive noninvasive tissue characterization. Delayed enhancement (DE) imaging is the cornerstone of cardiac MRI tissue characterization and allows accurate identification of myocardial fibrosis, conveying valuable additional diagnostic and prognostic information. The typical DE pattern in EMF, described as the "double V" sign, consists of a three-layered pattern of normal myocardium, thickened enhanced endomyocardium, and overlying thrombus at the apex of the affected ventricle; it has excellent correlation with histopathologic findings and plays an important role in differentiating EMF from other cardiomyopathies. Conversely, fibrous tissue deposition quantified using DE imaging, when indexed to body surface area, has been shown to be a strong independent predictor of mortality. The aim of this review is to summarize state-of-the-art applications of cardiac MRI for diagnostic and prognostic assessment of patients with suspected or confirmed EMF. Online supplemental material is available for this article. ©RSNA, 2020.
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Affiliation(s)
- Filipe Penna de Carvalho
- From Diagnósticos da America (DASA), Rio de Janeiro, Brazil (F.P.d.C., C.F.A.); Americas Serviços Médicos, Rio de Janeiro, Brazil (F.P.d.C.); and Division of Cardiology, Duke University Medical Center, Duke Medical Pavilion, 10 Medicine Circle, Room 1E63, DUMC 3934, Durham, NC 27710 (C.F.A.)
| | - Clerio Francisco Azevedo
- From Diagnósticos da America (DASA), Rio de Janeiro, Brazil (F.P.d.C., C.F.A.); Americas Serviços Médicos, Rio de Janeiro, Brazil (F.P.d.C.); and Division of Cardiology, Duke University Medical Center, Duke Medical Pavilion, 10 Medicine Circle, Room 1E63, DUMC 3934, Durham, NC 27710 (C.F.A.)
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17
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Yuan Y, Li Y, Xu Z. A case presentation of patient from northern China with endomyocardial fibrosis. BMC Cardiovasc Disord 2019; 19:313. [PMID: 31878882 PMCID: PMC6933696 DOI: 10.1186/s12872-019-01305-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 12/10/2019] [Indexed: 11/18/2022] Open
Abstract
Background Endomyocardial fibrosis (EMF) is a rare condition and a major cause of death in tropical countries. The etiology of EMF remains elusive, and no specific treatment has been developed yet, therefore it carries poor prognosis. Case presentation An 81-year-old male Chinese patient with a history of long-standing exertional breathlessness, presented with worsening symptoms rapidly evolving to orthopnea. A proper specific treatment was prescribed to the patient in the following days, including diuretics, angiotensin-converting-enzyme inhibitor and beta blockers. The patient died of progressive multiple organ failure. Conclusion Echocardiography is technically limited due to the acoustic shadowing as a result of the calcification. Chest computed tomography is a more accurate diagnostic tool to examine the anatomic distribution and extent of endomyocardial calcification in this rare case.
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Affiliation(s)
- Yonggang Yuan
- Department of Cardiology, Cangzhou Central Hospital, Cangzhou, 061000, Hebei, China
| | - Yingkai Li
- Department of Cardiology, Cangzhou Central Hospital, Cangzhou, 061000, Hebei, China
| | - Zesheng Xu
- Department of Cardiology, Cangzhou Central Hospital, Cangzhou, 061000, Hebei, China.
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18
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García-Granja PE, Pombo-Otero J, Barriales-Villa R. Isolated right ventricle endomyocardial fibrosis. An increasingly frequent disease in Spain. Med Clin (Barc) 2019; 153:219-220. [PMID: 30146360 DOI: 10.1016/j.medcli.2018.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 06/19/2018] [Accepted: 06/21/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Pablo Elpidio García-Granja
- Servicio de Cardiología, Instituto de Ciencias del Corazón (ICICOR), Hospital Clínico Universitario de Valladolid, Valladolid, España.
| | - Jorge Pombo-Otero
- Servicio de Anatomía Patológica, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), Servizo Galego de Saúde (SERGAS), Universidade da Coruña, A Coruña, España
| | - Roberto Barriales-Villa
- Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica de A Coruña (INIBIC), Servizo Galego de Saúde (SERGAS), Universidade da Coruña, A Coruña, España
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19
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Marangou J, Beaton A, Aliku TO, Nunes MCP, Kangaharan N, Reményi B. Echocardiography in Indigenous Populations and Resource Poor Settings. Heart Lung Circ 2019; 28:1427-1435. [DOI: 10.1016/j.hlc.2019.05.176] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 04/25/2019] [Accepted: 05/17/2019] [Indexed: 01/07/2023]
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20
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Lipshultz SE, Law YM, Asante-Korang A, Austin ED, Dipchand AI, Everitt MD, Hsu DT, Lin KY, Price JF, Wilkinson JD, Colan SD. Cardiomyopathy in Children: Classification and Diagnosis: A Scientific Statement From the American Heart Association. Circulation 2019; 140:e9-e68. [PMID: 31132865 DOI: 10.1161/cir.0000000000000682] [Citation(s) in RCA: 145] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In this scientific statement from the American Heart Association, experts in the field of cardiomyopathy (heart muscle disease) in children address 2 issues: the most current understanding of the causes of cardiomyopathy in children and the optimal approaches to diagnosis cardiomyopathy in children. Cardiomyopathies result in some of the worst pediatric cardiology outcomes; nearly 40% of children who present with symptomatic cardiomyopathy undergo a heart transplantation or die within the first 2 years after diagnosis. The percentage of children with cardiomyopathy who underwent a heart transplantation has not declined over the past 10 years, and cardiomyopathy remains the leading cause of transplantation for children >1 year of age. Studies from the National Heart, Lung, and Blood Institute-funded Pediatric Cardiomyopathy Registry have shown that causes are established in very few children with cardiomyopathy, yet genetic causes are likely to be present in most. The incidence of pediatric cardiomyopathy is ≈1 per 100 000 children. This is comparable to the incidence of such childhood cancers as lymphoma, Wilms tumor, and neuroblastoma. However, the published research and scientific conferences focused on pediatric cardiomyopathy are sparcer than for those cancers. The aim of the statement is to focus on the diagnosis and classification of cardiomyopathy. We anticipate that this report will help shape the future research priorities in this set of diseases to achieve earlier diagnosis, improved clinical outcomes, and better quality of life for these children and their families.
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21
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Sharma A, Pandey NN, Malhi AS, Kumar S. Complex right atrial mass in endomyocardial fibrosis: a diagnostic dilemma. BMJ Case Rep 2019; 12:12/1/e227131. [PMID: 30612105 DOI: 10.1136/bcr-2018-227131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Endomyocardial fibrosis, though a vanishing disease from India, remains an important cause of heart failure in children, adolescents and young adults. It may be complicated with arrhythmias and thromboembolism and is an important cause of mortality and morbidity. Moreover, usual presentation of this condition is in advanced stage with poor prognosis. Ventricular endocardial fibrosis with organised thrombus is the hall mark of this entity. Presence of associated cardiac mass poses a diagnostic challenge. We present one such case of endomyocardial fibrosis, in which a large thrombus was seen adherent to the anterolateral wall of right atrium, posing further risk of thromboembolism with complex management issues.
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Affiliation(s)
- Arun Sharma
- Cardiovascular radiology and endovascular interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Niraj Nirmal Pandey
- Cardiovascular radiology and endovascular interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Amarinder Singh Malhi
- Cardiovascular radiology and endovascular interventions, All India Institute of Medical Sciences, New Delhi, India
| | - Sanjeev Kumar
- Cardiovascular radiology and endovascular interventions, All India Institute of Medical Sciences, New Delhi, India
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22
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Conte L, Fejzo M, Rossi A, Zuin M, Roncon L. Endomyocardial Fibrosis: A Rare Case of Diastolic Heart Failure in a European Caucasian Elderly Woman. Heart Lung Circ 2018; 27:e31-e33. [DOI: 10.1016/j.hlc.2017.06.732] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/16/2017] [Accepted: 06/29/2017] [Indexed: 11/16/2022]
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23
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Herrera CJ, Piña P, Martínez J, García MJ. Cardiac Imaging in Systemic Diseases: What the Clinician should Know. Curr Cardiol Rev 2018; 14:175-184. [PMID: 29623849 PMCID: PMC6131404 DOI: 10.2174/1573403x14666180406100315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 03/06/2018] [Accepted: 03/29/2018] [Indexed: 11/22/2022] Open
Abstract
IMPORTANCE Systemic diseases that affect the cardiovascular system constitute a diagnostic and therapeutic challenge for all specialists involved; imaging tools along with clinical suspicion play an essential role in their evaluation. These entities share neurological, immunological, renal, hematologic, oncologic, infectious and endocrine processes, all of which may have associated cardiac involvement. OBSERVATIONS Recent advances in cardiac ultrasound, Computed Tomography (CT), cardiac Magnetic Resonance (CMR) and nuclear scintigraphy have impacted the management of these conditions when involving the heart since they provide valuable anatomical and functional information while avoiding the use of invasive techniques. For this review, bibliographic sources were gathered from diverse databases, including PubMed, Cochrane, EBSCO and Google Scholar, concentrating on English language publications dealing with the clinical use of these tools. CONCLUSION Clinical suspicion should always guide the use of imaging since in many instances, these techniques only play a supportive role rather than representing a diagnostic gold standard. Early diagnosis is critical due to the fact that cardiac manifestations are commonly a late phenomenon.
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Affiliation(s)
- César J. Herrera
- Address correspondence to this author at the Department of Cardiology, CEDIMAT Cardiovascular Center, Santo Domingo, Dominican Republic and Montefiore Center for Heart & Vascular Care, Albert Einstein College of Medicine, New York, NY, United States; Tel: 809-565-9989, Ext. 2044; E-mail:
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24
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Abstract
Restrictive cardiomyopathy (RCM) is characterized by nondilated left or right ventricle with diastolic dysfunction. The restrictive cardiomyopathies are a heterogenous group of myocardial diseases that vary according to pathogenesis, clinical presentation, diagnostic evaluation and criteria, treatment, and prognosis. In this review, an overview of RCMs will be presented followed by a detailed discussion on 3 major causes of RCM, for which tailored interventions are available: cardiac amyloidosis, cardiac sarcoidosis, and cardiac hemochromatosis. Each of these 3 RCMs is challenging to diagnose, and recognition of each disease entity is frequently delayed. Clinical clues to promote recognition of cardiac amyloidosis, cardiac sarcoidosis, and cardiac hemochromatosis and imaging techniques used to facilitate diagnosis are discussed. Disease-specific therapies are reviewed. Early recognition remains a key barrier to improving survival in all RCMs.
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Affiliation(s)
- Eli Muchtar
- From the Division of Hematology (E.M., M.A.G.) and Department of Cardiovascular Medicine (L.A.B.), Mayo Clinic, Rochester, MN
| | - Lori A. Blauwet
- From the Division of Hematology (E.M., M.A.G.) and Department of Cardiovascular Medicine (L.A.B.), Mayo Clinic, Rochester, MN
| | - Morie A. Gertz
- From the Division of Hematology (E.M., M.A.G.) and Department of Cardiovascular Medicine (L.A.B.), Mayo Clinic, Rochester, MN
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