Value of two-dimensional echocardiography in endomyocardial disease with and without eosinophilia. A clinical and pathologic study.

Abstract

SUMMARY Ten patients (six women and four men) with endomyocardial disease, four with and six without hypereosinophilia, were studied by two-dimensional echocardiography (2-D echo). Eight had biventricular congestive heart failure and two had atypical chest pain with ischemic electrocardiographic changes. The patients were 15-50 years old (mean 40 years) and duration of illness was 2-9 years (mean 4.4 years). Nine had cardiac catheterization and three pathologic examination.Characteristic 2-D echo findings included apical obliteration of one or both ventricles by echogenic material suggestive of fibrosis or thrombosis; bright, specular echoes at the cavity surface of the apical obliteration suggesting patchy calcification; preserved left apical systolic inward motion, which differed significantly from the dyskinetic motion of thrombotic apical obliteration of ischemic or Chagasic origin (p < 0.001); involvement of the papillary muscles and posterior atrioventricular valve; preserved ventricular contractile function in most patients; and the combination of normal-to-small ventricles with large atria. None of 14 subjects with secondary hypereosinophilia followed for 15.4 months developed similar 2-D echo findings.We conclude that both forms of endomyocardial disease had a 2-D echo pattern useful for noninvasive recognition and differentiation from patients who have valvular heart disease, constrictive pericarditis and cardiomyopathies of other origins.

Loeffler endocarditis: What have we learned?

“…The characteristic 2D echo findings include endocardial thickening, apical obliteration of one or both ventricles by an echogenic material suggestive of fibrosis or thrombosis, hyperdynamic contraction of the spared ventricular walls with bilateral atrial enlargement, and a restrictive pattern in echo-Doppler [7][8][9]. Magnetic resonance imaging (MRI) allows an accurate functional and anatomical study, being also able to discriminate the tissue composition [10].…”

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

“…15 This pattern of FT distribution and appearance is clearly distinct from the homogeneous and exclusively endomyocardial distribution found in our EMF patient study population. In EMF patients, the apical systolic inward motion is commonly preserved, 23 differing from the dyskinetic motion of thrombotic apical …”

Endomyocardial Fibrosis: Clinical, Echocardiographic and Hemodynamic Findings

“…The characteristic findings were obliteration of the apex of the involved ventricle, a grossly dilated atrium with a normal size ventricle, and thickening of the posterior left ventricular wall or anterior interventricular septum in patients with left or right-sided involvement, respectively [18][19][20]. One condition which mimics right-sided EMF is Behcet disease when obliteration of the right ventricular apex by clot without tricuspid regurgitation may occur [24].…”