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Results for “ENDOMYOCARDIAL FIBROSIS”

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PubMed1992

Tissue eosinophilia and eosinophil degranulation in syndromes associated with fibrosis.

Eosinophilia has long been associated with endomyocardial fibrosis, but the involvement of the eosinophilia in fibrosis of other organs is unclear. To investigate this question, the authors tested whether tissue eosinophilia and eosinophil degranulation are present in syndromes associated with fibrosis. The authors used an indirect immunofluorescent technique to localize eosinophil granule major basic protein (MBP) in formalin-fixed, paraffin-embedded tissue specimens from 50 patients. Thirty-four specimens were obtained from patients with inflammatory fibrosis: 12 with idiopathic retroperitoneal fibrosis, seven with sclerosing mediastinitis, four with sclerosing cholangitis, and 11 with pulmonary fibrosis. The remaining 16 specimens were obtained from patients with noninflammatory fibrous proliferations: four with keloids, six with scars, three with Dupuytren's contracture and three with dense stromal fibrosis of the breast. Eosinophil infiltration and/or extracellular MBP deposition were observed in 28 of the 34 specimens (82%) from patients with inflammatory fibrosis, including 11 of the 12 cases of retroperitoneal fibrosis, five of the seven cases of sclerosing mediastinitis, all four cases of sclerosing cholangitis, and 8 of the 11 cases of pulmonary fibrosis. In contrast, eosinophil infiltration and MBP deposition were not observed in specimens from the 16 patients with noninflammatory fibrous proliferation (P less than 0.001). These results indicate that eosinophil infiltration and release of a granule protein, namely MBP, commonly occur in inflammatory fibrotic lesions.

Adult↗

PubMed1998

Pattern of cardiac fibrosis in rabbits periodically fed a magnesium-restricted diet and administered rare earth chloride through drinking water.

It has been postulated that causation of the tropical cardiomyopathy endomyocardial fibrosis (EMF) is linked to magnesium (Mg) deficiency and cardiac toxicity of the rare earth element cerium (Ce). The aim of the present study was to define the myocardial lesions in rabbits that were fed on Mg-restricted diet (70-80 ppm) periodically and were provided drinking water contaminated with rare earth chloride (1 g/L). Forty New Zealand white rabbits were divided into four groups following a 2 x 2 factorial design. Two groups were periodically fed on Mg-restricted diet with one of them receiving water contaminated with rare earth chloride. The other two groups were continuously fed on Mg-sufficient diet (350-400 ppm) with one of them receiving water contaminated with rare earth chloride. All animals were sacrificed at the end of 6 mo. Cardiac tissues were subjected to histology, elemental analysis (calcium [Ca], Mg, and Ce) and estimation of collagen content and collagen phenotypes. Histological lesions were compared with those of EMF in humans and those of acute Mg deficiency in animals. The results suggest that in rabbits, recurrent episodes of Mg deficiency lead to myocardial fibrosis similar to the pattern observed in human EMF.

Animals↗

PubMed1992

Cardiomyopathies and specific heart muscle diseases. Definitions, terminology, classifications and new and old approaches.

Cardiomyopathies are defined as 'heart muscle diseases of unknown cause' and classified into hypertrophic, dilated and restrictive types, respectively. Hypertrophic cardiomyopathy is notable for massive ventricular hypertrophy without obvious cause, impaired diastolic and systolic function, a tendency for sudden death and a familial propensity. Dilated cardiomyopathy by contrast, demonstrates severe systolic failure progressing to congestive heart failure, with usually no familial tendency. Restrictive cardiomyopathy and diastolic heart disease represent syndromes with restriction to ventricular filling due to restrictive forces in the endomyocardium (and in constrictive pericarditis in the pericardium). The commonest cause of restrictive cardiomyopathy is endomyocardial fibrosis now usually known as hypereosinophilic endomyocardial disease. Specific heart muscle diseases are those conditions in which myocardial disease is due to a known cause: they usually produce systolic failure though occasionally a restrictive syndrome is evident. Amyloid heart disease occupies a place intermediate between cardiomyopathies and specific heart muscle diseases. The major features of the above conditions are described and current and future advances noted. Examples are the identification of the gene probably responsible for hypertrophic cardiomyopathy located on chromosome 14, and the identification of virus RNA particles in the myocardium in both myocarditis and in dilated cardiomyopathy, which strengthens the growing evidence suggesting that some cases of dilated cardiomyopathy may be due to previous myocarditis.

Cardiomyopathies↗

PubMed1989

Persisting hypereosinophilia and myocardial activity in the fibrotic stage of endomyocardial disease.

An unusual case of endomyocardial fibrosis is reported complicating an idiopathic hypereosinophilic syndrome. Persisting hypereosinophilia, degranulated eosinophils in the blood, and myocardial activity have been found accompanying the fibrotic phase of endomyocardial disease. This occurrence supports the unitarian theory on tropical and temperate endomyocardial disease and suggests in such a condition the use of steroids or cytotoxic drugs in addition to surgery.

Endocardium↗

PubMed2005

Heart involvement in T cell lymphoma through hypereosinophilic syndrome: a common complication of a rare condition.

This case describes a 42-year-old male affected by hypereosinophilic syndrome associated with angioimmunoblastic lymphoma. Heart involvement was suspected at ECG mimicking left ventricular hypertrophy. MRI clarified the extensive endomyocardial fibrosis, confirming the role of this technique in in-vivo tissue characterization. Finally, the study investigates the association of T cell lymphoma, hypereosinophilic syndrome, and Loeffler endomyocardial disease.

Adult↗

PubMed1990

Ventricular arrhythmias in hypertensive left ventricular hypertrophy. Relationship to coronary artery disease, left ventricular dysfunction, and myocardial fibrosis.

Ventricular arrhythmias occur with increased frequency in hypertensive patients with left ventricular hypertrophy (LVH). The relationships, however, between ventricular arrhythmias and coexistent coronary artery disease, left ventricular dysfunction and left ventricular fibrosis have not been examined in hypertensive LVH. We carried out coronary arteriography on fifteen hypertensive patients with LVH and nonsustained ventricular tachycardia (greater than or equal to 3 consecutive ventricular complexes) of whom nine (60%) were free of significant (greater than 50% stenosis) coronary disease. To identify other possible correlates of left ventricular arrhythmias, 28 patients with LVH, comprising 17 with ventricular tachycardia and 11 without ventricular arrhythmias, underwent quantitative assessment of left ventricular function (angiographic ejection fraction), left ventricular mass (echocardiography), and left ventricular fibrosis (endomyocardial biopsy). Ejection fraction was not significantly different between the two groups (53 +/- 8% v 62 +/- 2%, P = NS). However, left ventricular mass was significantly greater (442 +/- 28 g v 339 +/- 34 g, P less than .05) and percentage fibrosis significantly higher (19 +/- 4% v 3 +/- 1%, P less than .001) in those patients with ventricular tachycardia. Thus ventricular arrhythmias in hypertensive patients with LVH cannot be entirely attributed to coexistent coronary disease, nor to left ventricular dysfunction, but are related to the degree of cardiac hypertrophy and subendocardial fibrosis.

Biopsy↗

PubMed2005

Porcelain heart: a case of massive myocardial calcification.

Reports of massive myocardial calcification are limited mainly to case reports and this type intracardiac calcifications have been usually identified postmortem. We present a very interesting case of massive calcification of the left ventricular myocardium, interventricular and interatrial septae causing restrictive physiology and coronary artery obstruction in a 46-year-old Turkish woman. The diagnosis of myocardial calcification was suspected from chest X-ray and confirmed with computerized tomography and cardiac catheterization. The findings of the chest computed tomography were very similar to those previously reported cases of endomyocardial fibrosis (EMF) with massive calcification of the left ventricle.

Calcinosis↗

PubMed2005

[Biventricular endomyocardiofibrosis associated with renal amyloidosis].

Endomyocardiofibrosis is a restrictive cardiomyopathy characterized by fibrotic involvement of the endocardium and adjacent myocardium, and by diastolic dysfunction caused by changes in distensibility making ventricular filling inadequate while preserving the systolic function. Clinically, it appears as heart failure, but etiological symptomatic discernment, suspicion and a clinical examination would be necessary in order to make a correct etiological diagnosis. The case of a patient with biventricular endomyocardial fibrosis associated with renal amyloidosis is presented.

Amyloidosis↗

PubMed1983

Cardiovascular features of 11 patients with eosinophilic endomyocardial disease.

This report describes the clinical features, cardiac investigations and treatment of eleven patients with biventricular eosinophilic endomyocardial disease, who were followed up for a mean of 3.2 years. Three patients died. Five patients presented with heart disease and hypereosinophilia. Six other patients presented with hypereosinophilia and developed cardiac disease later. Histological studies showed early acute necrotic lesions in five patients, later thrombotic lesions in one and late fibrotic lesions in three patients. Endomyocardial biopsy was the method of choice for diagnosing early acute necrotic and thrombotic lesions. Late fibrotic lesions were best shown by amplitude processed 2D echocardiography and angiocardiography. Episodes of heart failure responded well to treatment with prednisolone which appeared to inhibit progression of heart disease in two patients. Three patients with severe ventricular disease and valvular regurgitation responded well to surgical treatment. This longitudinal study has shown that eosinophilic endomyocardial disease can now be investigated and treated effectively at each stage from early sub-clinical lesions to late incapacitating endomyocardial fibrosis.

Adult↗

PubMed1987

Deposits of eosinophil granule proteins in cardiac tissues of patients with eosinophilic endomyocardial disease.

Eosinophilic endomyocardial disease is a complication of the hypereosinophilic syndrome and of several other disorders associated with high blood eosinophil counts. Eosinophil granule proteins may be involved in the development of these lesions. This multi-centre study investigated whether these proteins could be demonstrated within the cardiac tissues of eighteen patients with eosinophilic endomyocardial disease. Serial sections of tissue taken at necropsy or at cardiac biopsy were stained for eosinophil major basic protein by indirect immunofluorescence and for eosinophil cationic protein, eosinophil protein-X, and activated eosinophils by means of alkaline-phosphatase-linked monoclonal antibodies. Activated eosinophils and secreted eosinophil granule proteins were most evident within the necrotic and later stage thrombotic lesions and were found mainly within the areas of acute tissue damage in the endocardium and in the walls of small blood vessels. These findings suggest that eosinophil granule proteins are involved in cardiac injury, producing muscle damage and vascular injury which lead to the development of endomyocardial fibrosis.

Acute Disease↗

PubMed1977

Unique eosinophil granules in a case of T-cell lymphoma.

A 41-year-old man developed intense itching without visible cutaneous changes, epigastric pressure pain, and a slight intolerance to alcohol. He was found to have persistent blood eosinophilia. The eosinophil granulocytes were of abnormal appearance in the light microscope: larger than normal, the nuclei were multilobulated (4-6 lobes), the cytoplasm contained atypical, large granules, ample glycogen, and up to 12 vacuoles. In the electron microscope too the eosinophil granules were entirely atypical, having an electron-dense matrix, often with a light central inclusion body which was inhomogeneous, having longitudinally oriented structures with a periodicity of about 10 nm. These findings are quite contrary to normal eosinophil granules. Enzymic studies of cytoplasmic enzymes from the granulocytes revealed a greatly reduced content of eosinophil cationic proteins, whereas 5 (7) other enzymes were present in a normal or slightly reduced quantity. The phagocytic capacity of the eosinophils against latex particles was normal. The patient developed generalized lymphomas, histologically very malignant, of the convoluted, acid phosphatase positive cell type (T-cell lymphoma). Sub-population studies of lymphocytes from a lymph node revealed 58% TE cells, while the remainder were B cells. At death, 3-1/2 years after the onset of symptoms, severe endomyocardial fibrosis was found. The thymus could not be identified. It is concluded that lymphomas should be described on the bais of clinical, histological, and histochemical criteria as well as studies of lymphocyte sub-populations and that the highly unusual eosinophil granulocytes still deserve particular attention. The endocardial fibrosis is assumed to have been due to substances liberated from the eosinophil cells.

Acid Phosphatase↗

PubMed2003

[Usefulness of magnetic resonance imaging in the assessment of endomyocardial disease].

Endomyocardial disease is a restrictive cardiomyopathy that includes Löffler endocarditis, which is characterized by hypereosinophilia, and endomyocardial fibrosis, which is not. Echocardiography enables cardiac function and anatomy to be assessed and the differential diagnosis of other causes of restrictive disease, but magnetic resonance imaging provides information about the tissue itself. Furthermore, paramagnetic contrast agents are useful in detecting myocardial abnormalities. We report three cases of endomyocardial disease and the typical findings of magnetic resonance imaging.

Adolescent↗

PubMed1986

[Diagnostic contribution of endomyocardial biopsy in suspected latent cardiomyopathy].

Twenty-eight patients with suspected diagnosis of latent cardiomyopathy are reported. In all patients left ventricular endomyocardial biopsy (five or more specimens) was performed after noninvasive and invasive investigations. The indication to investigate invasively arose from clinical symptoms in combination with uncertain ECG disturbances. Coronary heart disease, latent myocarditis and latent cardiomyopathy were to be excluded. Hemodynamic parameters proved to be normal or borderline at rest. Angiocardiography and coronary angiography revealed no pathological findings. But in all cases the histological results of endomyocardial biopsy were characterized by pathological criteria as follows: inflammatory myocardial process, narrowing or obliterating diseases of intramural small arteries, exogenous-toxic myocardial disturbances, idiopathic cardiomyopathy, endomyocardial fibrosis with endocardial thrombus and infiltrations of eosinophiles. Four cases are demonstrated as examples.

Adult↗

PubMed1979

The clinical and aetiological pattern of finger clubbing and hypertrophic osteoarthropathy in Nigerians.

A study of the clinical and aetiological patterns of finger clubbing and hypertrophic osteoarthropathy was carried out over a 15-year period. 116 patients were studied. Pain is not a common symptom in patients with finger clubbing and osteoarthropathy in Nigerians, contrary to what has been reported in the literature. The cause of finger clubbing is predominantly pulmonary in origin, being responsible in 84 per cent of cases. The commonest cause in bronchiectasis, followed by empyema thoracis, bronchial carcinoma and lung abscess. Among the nonpulmonary causes are infective endocarditis, endomyocardial fibrosis and cirrhosis of liver. Hypertrophic osteoarthropathy is found in 15 cent of the patients with finger clubbing, the commonest cause being carcinoma of the bronchus.

Adolescent↗

PubMed2003

[Left ventricular dysfunction in Churg-Strauss syndrome].

Churg-Strauss syndrome is a rare disorder characterized by hypereosinophilia and a systemic vasculitis occurring inpatients with asthma and allergic rhinitis. Vasculitis commonly affects the lungs, the heart, the skin, and the peripheral nervous system. Cardiac involvement is characterized by acute and constrictive pericarditis, myocarditis and endocarditis, as well as ischemic cardiomyopathy. Endomyocardial fibrosis similar to Loeffler's syndrome has been rarely described. In the presented case, a 43 year old man with a history of allergy and asthma suffered from increasing dyspnea, fever, pulmonary infiltates and cardiomyopathy. Laboratory studies were notable for marked hypereosinophilia. In a bronchoscopic lavage and transbronchial biopsy eosinophilic infiltrates accompanied by vasculitis were found, Churg-Strauss syndrome was diagnosed. Echocardiogram showed endomyocardial deposits in the apex of the right ventricle, right ventricular function was normal particular in the basal segments. The left ventricle was slightly enlarged and left ventricular function was impaired. The diastolic mitral in-flow showed a restrictive pattern. Additionally, a pericardial effusion was observed without signs of tamponade. The patient received corticosteroids, cyclophosphamide and cardiomyopathy-specific therapy and showed a marked improvement after 4 months.

Adult↗

PubMed1985

Hypereosinophilic heart disease.

A 45-year-old patient with cardiac involvement from the idiopathic hypereosinophilic syndrome suffered from severe congestive cardiac failure with progressive deterioration despite intensive medical therapy. Investigations indicated bilateral ventricular infiltration with endomyocardial fibrosis which had caused severe haemodynamic restriction and bilateral atrioventricular valvular incompetence. Extensive surgery, which included bilateral ventricular endomyomectomy and mitral and tricuspid valve replacements, resulted in a significant improvement for six months.

Endomyocardial Fibrosis↗

PubMed1976

[Pathology of the "primary" cardiomyopathies (author's transl)].

The definition and clinical classification of the cardiomyopathies which the author uses are briefly mentioned, macroscopic, histologic, histochemical and electron microscopic appearances of the three clinical groups are described in detail. Classification is made into: 1. Congestive cardiomyopathy, 2a. hypertrophic cardiomyopathy with obstruction, 2b. hypertrophic cardiomyopathy without obstruction, 3. obliterative or restrictive cardiomyopathy. Löffler's endocarditis parietalis fibroplastica and endomyocardial fibrosis are examples which are compared with eosinophilic myocarditis and pathological evidence that the two diseases belong to the same disease process. The etiological possibilities of the cardiomyopathies are mentioned. Useful diagnostic information is obtained by myocardial biopsy in 68%.

Cardiomyopathies↗

PubMed1994

Eosinophilic endomyocardial disease due to high grade chest wall sarcoma.

Eosinophilic endomyocardial disease is characterised by persisting blood eosinophilia and acute endocardial lesions which progress to endomyocardial fibrosis. In most cases the cause is unknown but it has been described in association with malignant tumours. A fatal case is presented of a 64 year old woman with this disease due to a high grade sarcoma of the chest wall, an association not previously reported.

Endomyocardial Fibrosis↗