Loeffler’s Endocarditis: An Integrated Multimodality Approach

Polito, Maria Vincenza; Hagendorff, Andreas; Citro, Rodolfo; Prota, Costantina; Silverio, Angelo; Angelis, Elena De; Klingel, Karin; Metze, Michael; Stöbe, Stephan; Hoffmann, Karl‐Titus; Sabri, Osama; Piscione, Federico; Galasso, Gennaro

doi:10.1016/j.echo.2020.09.002

Cited by 31 publications

(43 citation statements)

References 71 publications

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“…The detection of LV apical thrombus is suggestive for Loeffler endocarditis when the myocardial contractility is preserved. 7 With the advent of multimodal noninvasive imaging techniques, IDH can now be diagnosed earlier and with greater reliability. 8 , 9 Echocardiographic diagnosis of septal and/or free wall IDH is based on the presence of at least three of the signs in Table 1 .…”

Section: Discussionmentioning

confidence: 99%

Left Ventricular Intramyocardial Dissecting Hematoma

Tanabe

Okazaki

Endo

et al. 2021

CASE

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Section: Discussionmentioning

confidence: 99%

Left Ventricular Intramyocardial Dissecting Hematoma

Tanabe

Okazaki

Endo

et al. 2021

CASE

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show abstract

Section: Discussionmentioning

confidence: 99%

“…Transthoracic echocardiography plays an important role in both diagnosis and follow-up 5 . The most common echocardiographic fi ndings are endomyocardial thickening, left or right mural thrombus, frequently in apex, small ventricular cavity due to endocardial thickening and mural thrombus, atrioventricular valves implication with mitral or tricuspid regurgitation, biatrial enlargement, and pericardial effusion 5 . Cardiac magnetic resonance is crucial for LE diagnosis due to detection and characterization of ventricular thrombi and early detection of subendocardial thickening associated with myocardial tissue abnormalities.…”

Section: Discussionmentioning

confidence: 99%

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Löeffler endocarditis due to idiopathic hypereosinophilic syndrome

Benchea

Clément

Nedelcu

et al. 2021

Romanian Journal of Cardiology

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Hypereosinophilic syndrome encompasses a heterogenous group of non-hematologic and hematologic disorders defined as peripheral blood eosinophilia >1500/mm3 persisting more than 6 months and eosinophilic end organ complications. Löeffl er endocarditis (LE) is the most common cardiac manifestation of the hypereosinophilic syndrome (HES) and represents an acute form of primary restrictive cardiomyopathy. We report the case of a 74 years-old woman with symptoms related to congestive heart failure and weight loss. At admission the patient had tachycardia and a grade 2/6 systolic mitral murmur. Laboratory findings revealed eosinophilia, hepatocytolysis syndrome and dyslipidemia. The electrocardiogram (ECG) showed non-specific ST-segment and T wave abnormalities. The echocardiography revealed left ventricular apical thrombus and entrapment of chordae tendineae with restricted motion of mitral leaflets leading to mitral regurgitation. The diagnosis of myocarditis was confirmed by the cardiac magnetic resonance imaging which showed the presence of a left ventricular mass with low signal on steady-state free precession imaging and diffuse circumferential subendocardial late gadolinium enhancement (LGE). When discussing the etiology of the HES the following were taken into consideration: hematologic, reactive or secondary disorders. This case is distinguished by diagnosis in an elderly woman and good response to corticosteroid therapy.

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“…Cardiac magnetic resonance (CMR) has the unique ability to identify non-invasively the inflammatory damage of myocardium, in localizing the sites of inflammation or fibrosis, and in assessing the presence and severity of functional impairment [ 24 – 26 ]. Recent CMR studies have shown that ongoing inflammation and residual fibrosis may be detected after COVID-19 resolution and subclinical myocardial abnormalities are still detectable several months after recovery.…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular Involvement in COVID-19: What Sequelae Should We Expect?

Polito¹,

Silverio

Bellino

et al. 2021

Cardiol Ther

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Several forms of cardiovascular involvement have been described in patients with Coronavirus disease 19 (COVID-19): myocardial injury, acute coronary syndrome, acute heart failure, myocarditis, pericardial diseases, arrhythmias, takotsubo syndrome, and arterial and venous atherothrombotic and thromboembolic events. Data on long-term outcome of these patients are still sparse, and the type and real incidence of cardiovascular sequelae are poorly known. It is plausible that myocardial injury may be the initiator of an inflammatory cascade, edema, and subsequent fibrosis, but also a consequence of systemic inflammation. The extent and distribution of ongoing inflammation may be the basis for ventricular dysfunction and malignant arrhythmias. Indeed, preliminary observational findings seem to emphasize the importance of close monitoring of COVID-19 patients with myocardial injury after discharge. Residual subclinical disease may be effectively investigated by using second-level imaging modalities such as cardiac magnetic resonance, which allows better characterization of the type and extension of myocardial damage, as well as of the ongoing inflammation after the acute phase. In patients with venous thromboembolism, a very common complication of COVID-19, the type and the duration of anticoagulation therapy after the acute phase should be tailored to the patient and based on the estimation of the individual thromboembolic and hemorrhagic risk. Large randomized clinical trials are ongoing to address this clinical question. Whether the severity of cardiovascular involvement, the type of treatments adopted during the acute phase, and the hemodynamic response, may influence the long-term outcome of patients recovered from COVID-19 is unknown. An etiological diagnosis of myocardial injury during the hospitalization is the first step for an appropriate follow-up in these patients. After discharge, the screening for residual left and right ventricular dysfunction, arrhythmias, residual thrombosis, and myocardial scar should be considered on a case-by-case basis, whereas an active clinical surveillance is mandatory in any patient.

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Loeffler’s Endocarditis: An Integrated Multimodality Approach

Cited by 31 publications

References 71 publications

Left Ventricular Intramyocardial Dissecting Hematoma

Left Ventricular Intramyocardial Dissecting Hematoma

Löeffler endocarditis due to idiopathic hypereosinophilic syndrome

Cardiovascular Involvement in COVID-19: What Sequelae Should We Expect?

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