Early Differential Resolution of Right and Left Ventricular Obliteration in Löffler Endocarditis After Chemotherapy and Anticoagulation

Bénézet-Mazuecos, Juan; Marcos‐Alberca, Pedro; Farré, Jerónimo; Orejas, Miguel; Fuente, Adolfo de la; Prieto, Elena

doi:10.1161/circulationaha.106.636753

Cited by 11 publications

(14 citation statements)

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“…Magnetic resonance imaging (MRI) allows an accurate functional and anatomical study, being also able to discriminate the tissue composition [10]. Gadolinium delayed-enhanced MRI accurately identifies regions of myocardial fibrosis and can be of diagnostic assistance when a ventricular thrombus is suspected [11]. Diffuse myocardial involvement may lead to heart failure, and some of these patients may later develop ventricular remodeling and dilated cardiomyopathy [12].…”

Section: Discussionmentioning

confidence: 99%

“…Anticoagulation in these cases not only prevents pulmonary or systemic embolic events and thrombus growth, but also limits the obliteration of the ventricular cavity, preventing the long-term left ventricular remodeling leading to systolic dysfunction [12]. While the vast majority of the literature emphasizes the importance of oral anticoagulation in Loeffler endocarditis, it has been suggested that anticoagulation should also be considered in prolonged hypereosinophilic states before the ventricular obliteration develops [11].…”

Section: Discussionmentioning

confidence: 99%

“…The evolution of the cardiac abnormalities varies from rapid changes in clinical and echocardiographic manifestations observed early after the initial diagnosis to an absence of changes for long periods of time [11,21]. It is not clear whether the variability of the therapeutic regimens used in this entity contribute to the different patterns of evolution of the cardiac disease [21].…”

Section: Discussionmentioning

confidence: 99%

“…It is not clear whether the variability of the therapeutic regimens used in this entity contribute to the different patterns of evolution of the cardiac disease [21]. It has been suggested that anticoagulation can solve the thrombotic component and the ventricular obliteration that can eventually disappear, but when the obliterating material is fibrotic in nature, anticoagulation and anti-eosinophils regimens may not work [11]. In this setting, gadolinium delayed-enhancement MRI can be useful to identify patients with ventricular obliteration who might eventually benefit from anticoagulation [10,11].…”

Section: Discussionmentioning

confidence: 99%

“…It has been suggested that anticoagulation can solve the thrombotic component and the ventricular obliteration that can eventually disappear, but when the obliterating material is fibrotic in nature, anticoagulation and anti-eosinophils regimens may not work [11]. In this setting, gadolinium delayed-enhancement MRI can be useful to identify patients with ventricular obliteration who might eventually benefit from anticoagulation [10,11]. Surgical treatment has been proposed in selected patients presenting with intraventricular fibrotic masses affecting cardiac hemodynamics [22].…”

Section: Discussionmentioning

confidence: 99%

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Loeffler endocarditis: What have we learned?

et al. 2007

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Loeffler endocarditis, eosinophilic endomyocardial disease or fibroplastic endocarditis appears to be a subcategory of the Hypereosinophilic syndrome in which the heart is predominantly involved. It is an uncommon myocardial disease, thought to be secondary to eosinophils damage, characterized by fibrous thickening of the endocardium of one or both ventricles, leading to apical obliteration and multiple cardiovascular complications. Despite all the efforts, the ultimate responsible mechanisms of this entity remain unresolved. Many theories have been raised trying to explain this phenomenon, but nowadays the enigma in relation to the different patterns of evolution continues. In this concise review we discuss the different pathophysiologic theories postulated and the management of the cardiovascular complications. Perhaps it will serve to assist in recognition of patients with the same condition around the world. Am. J. Hematol. 82:861–862, 2007. © 2007 Wiley‐Liss, Inc.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Loeffler endocarditis: What have we learned?

et al. 2007

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Fatal Loeffler's endocarditis due to hypereosinophilic syndrome

et al. 2007

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Hypereosinophilic syndrome (HES) is a rare disorder that can manifest in various organ systems. We report the case of a 54-year-old woman with a remote history of seizure disorder who presented with early signs of right-sided heart failure. Laboratory studies showed significant eosinophilia (8 x 10(9) l(-1)). Computed tomography showed heterogeneity of the liver, mild ascites, moderate pleural effusion, multiple small pulmonary emboli, and a large right ventricular mass. Cardiac magnetic resonance imaging demonstrated that the right ventricular mass was due to thrombus and extensive endomyocardial fibrosis, consistent with Loeffler's endocarditis. Bone marrow biopsy showed marked eosinophilia but no abnormal myeloid maturation or a lymphoproliferative disorder; flow cytometry showed no clonality. Extensive infectious, immunologic, and toxicological studies were negative. Despite resolution of peripheral eosinophilia with medical management, including corticosteroids and cytotoxic agents, anticoagulation for pulmonary emboli and ventricular thrombus, and conventional treatment for heart failure, she developed worsening anasarca and died from ventricular fibrillation within 4 weeks of presentation. Autopsy confirmed the diagnosis. Loeffler's endocarditis, usually a late manifestation of HES, is characterized by fibrous thickening of the endocardium, leading to apical obliteration and restrictive cardiomyopathy, resulting in heart failure, thromboembolic events, or atrial fibrillation. HES is a potentially fatal disease with less than 50% reported 10-year survival. This case presentation is unusual in its rapidly progressive course leading to sudden death.

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