Late Gadolinium Enhancement Magnetic Resonance Imaging in the Diagnosis and Prognosis of Endomyocardial Fibrosis Patients

Abstract

Background-Endocardial fibrous tissue (FT) deposition is a hallmark of endomyocardial fibrosis (EMF). Echocardiog-raphy is a first-line and the standard technique for the diagnosis of this disease. Although late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) allows FT characterization, its role in the diagnosis and prognosis of EMF has not been investigated. Methods and Results-Thirty-six patients (29 women; age, 54Ϯ12 years) with EMF diagnosis after clinical evaluation and comprehensive 2-dimensional Doppler echocardiography underwent cine-CMR for assessing ventricular volumes, ejection fraction and mass, and LGE-CMR for FT characterization and quantification. Indexed FT volume (FT/body surface area) was calculated after planimetry of the 8 to 12 slices obtained in the short-axis view at end-diastole (mL/m 2 ). Surgical resection of FT was performed in 16 patients. In all patients, areas of LGE were confined to the endocardium, frequently as a continuous streak from the inflow tract extending to the apex, where it was usually most prominent. There was a relation between increased FT/body surface area and worse New York Heart Association functional class and with increased probability of surgery (PϽ0.05). The histopathologic examination of resected FT showed typical features of EMF with extensive endocardial fibrous thickening, proliferation of small vessels, and scarce inflammatory infiltrate. In multivariate analysis, the patients with FT/body surface area Ͼ19 mL/m 2 had an increased mortality rate, with a relative risk of 10.8. Conclusions-Our study provides evidence that LGE-CMR is useful in the diagnosis and prognosis of EMF through quantification of the typical pattern of FT deposition. (Circ Cardiovasc Imaging. 2011;4:304-311.)

Isolated right ventricular endomyocardial fibrosis in a young male with chronic myeloid leukemia (RCD code: III-3F.2)

“…Recently, there has been a lot of interest in the use of cardiac magnetic resonance (CMR) in characterizing the features of EMF [18][19][20]. Late gadolinium enhancement using CMR delineates the endomyocardial fibrosis, which is the hallmark of EMF.…”

MRI-based Evidence for Myocardial Involvement in Women with Hypereosinophilic Syndrome

“…These findings support the link between eosinophil level and myocardial damage, which has been documented in endomyocardial biopsy samples. 18,34 Interestingly, Salemi and associates 35 demonstrated a relationship between the volume of LGE and mortality in subjects with endomyocardial fibrosis. However, the prognostic value of LGE lesions in the early stage of heart disease in HES remains to be determined.…”

Right ventricular endomyocardial fibrosis – A case report

“…Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) can also help in the diagnosis and prognosis of EMF. 9 CMR was not done in our case due to financial constraints. Endomyocardial biopsy is not essential to diagnose EMF.⁴ Medical management usually includes treatment with diuretics and anticoagulants.…”