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Visualization of Endomyocardial Fibrosis by Delayed-Enhancement Magnetic Resonance Imaging

2005; Lippincott Williams & Wilkins; Volume: 111; Issue: 9 Linguagem: Inglês

10.1161/01.cir.0000157399.96408.36

1524-4539

Ricardo C. Cury, Suhny Abbara, Larry J-Diaz Sandoval, Stuart L. Houser, Thomas J. Brady, Igor F. Palacios,

Cardiac tumors and thrombi

HomeCirculationVol. 111, No. 9Visualization of Endomyocardial Fibrosis by Delayed-Enhancement Magnetic Resonance Imaging Free AccessReview ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissionsDownload Articles + Supplements ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toSupplemental MaterialFree AccessReview ArticlePDF/EPUBVisualization of Endomyocardial Fibrosis by Delayed-Enhancement Magnetic Resonance Imaging Ricardo C. Cury, Suhny Abbara, Larry J-Diaz Sandoval, Stuart Houser, Thomas J. Brady and Igor F. Palacios Ricardo C. CuryRicardo C. Cury From the Department of Radiology (R.C.C., S.A., T.J.B.), the Division of Cardiology (L.J.-D.S., I.F.P.), and the Department of Pathology (S.H.), Massachusetts General Hospital, Boston, Mass. , Suhny AbbaraSuhny Abbara From the Department of Radiology (R.C.C., S.A., T.J.B.), the Division of Cardiology (L.J.-D.S., I.F.P.), and the Department of Pathology (S.H.), Massachusetts General Hospital, Boston, Mass. , Larry J-Diaz SandovalLarry J-Diaz Sandoval From the Department of Radiology (R.C.C., S.A., T.J.B.), the Division of Cardiology (L.J.-D.S., I.F.P.), and the Department of Pathology (S.H.), Massachusetts General Hospital, Boston, Mass. , Stuart HouserStuart Houser From the Department of Radiology (R.C.C., S.A., T.J.B.), the Division of Cardiology (L.J.-D.S., I.F.P.), and the Department of Pathology (S.H.), Massachusetts General Hospital, Boston, Mass. , Thomas J. BradyThomas J. Brady From the Department of Radiology (R.C.C., S.A., T.J.B.), the Division of Cardiology (L.J.-D.S., I.F.P.), and the Department of Pathology (S.H.), Massachusetts General Hospital, Boston, Mass. and Igor F. PalaciosIgor F. Palacios From the Department of Radiology (R.C.C., S.A., T.J.B.), the Division of Cardiology (L.J.-D.S., I.F.P.), and the Department of Pathology (S.H.), Massachusetts General Hospital, Boston, Mass. Originally published8 Mar 2005https://doi.org/10.1161/01.CIR.0000157399.96408.36Circulation. 2005;111:e115–e117An 18-year-old Venezuelan woman, with a history of idiopathic restrictive cardiomyopathy, presented at our hospital with ongoing dyspnea, palpitations, and lightheadedness. A medical evaluation revealed heart failure, pulmonary hypertension, and heparin-induced thrombocytopenia.Cardiac catheterization revealed normal coronary arteries. The left ventriculogram demonstrated late filling of the apex, which was almost obliterated by prominent trabeculations. Moderate mitral regurgitation with significant enlargement of the left atrium was observed. The ejection fraction was 44%, without regional wall motion abnormalities (Figure 1). Download figureDownload PowerPointFigure 1. End-systolic (A) and end-diastolic (B) frames of the left ventriculography show partial obliteration of the cavity with late filling of the apex, which was occupied by prominent trabeculations and moderate mitral regurgitation.Cine MRI (steady-state free-precession technique) demonstrated systemic venous dilatation, moderate pericardial effusion, right and left atrial dilatation, and mitral and tricuspid regurgitation (TR) (Figures 2 and 3, Movies I and II). The origin of the TR jet was dislocated toward the apex of the right ventricle, originating within the right ventricular cavity, possibly secondary to papillary muscle fibrosis (Figure 2, Movie I). Delayed-enhancement MRI image was acquired via an inversion recovery technique after injection of 0.2 mmol/kg of gadolinium (Gd-DTPA). The MRI revealed subendocardial hyperenhancement of the apex of the left ventricle, suggesting fibrosis (Figure 4). This technique has been used to detect irreversible myocardial injury (fibrosis or necrosis). Download figureDownload PowerPointFigure 2. Steady-state free-precession 4-chamber view cine MRI demonstrates right and left atrial dilatation and TR, with the origin of the TR jet dislocated toward the apex of the right ventricle (RV; arrow), possibly secondary to papillary muscle fibrosis. RA indicates right atrium; LA, left atrium; and LV, left ventricle.Download figureDownload PowerPointFigure 3. Steady-state free-precession cine MRI demonstrates left atrial dilatation and mitral regurgitation (arrow). RVOT indicates right ventricular outflow tract; other abbreviations as in Figure 2.Download figureDownload PowerPointFigure 4. Delayed-enhancement MRI of left ventricle radial view demonstrates subendocardial hyperenhancement of the apex of the left ventricle, suggesting fibrosis (arrows). Abbreviations as in Figure 2.A myocardial biopsy of the right ventricle confirmed the presence of endomyocardial fibrosis. The patient underwent endomyocardial stripping, mitral valve replacement, and tricuspid ring valvuloplasty. Postoperatively, the patient developed refractive congestive heart failure, which progressed to cardiogenic shock and death. Histological examination of the heart revealed endomyocardial fibrosis, involving particularly the ventricles and left atrium (Figures 5 and 6). Download figureDownload PowerPointFigure 5. At autopsy, the left ventricular apex was obliterated by prominent trabeculations and fibrosis (mushroom sign; arrows).Download figureDownload PowerPointFigure 6. Histology of the LA demonstrates marked fibrotic thickening of the endocardium (arrow), with proliferation of fibrous tissue in the underlying myocardium, which is consistent with endomyocardial fibrosis (Masson trichrome stain, original magnification ×50).Delayed-enhancement MRI technique allows the detection of subendocardial fibrosis with good histopathological correlation, providing a comprehensive tool for noninvasive assessment of endomyocardial fibrosis.The online-only Data Supplement, which contains Movies I and II, is available with this article at http://www.circulationaha.org.FootnotesCorrespondence to Ricardo C. Cury, MD, Dept of Radiology, Massachusetts General Hospital, 100 Charles River Plaza, Ste 400, Boston, MA 02114. E-mail [email protected] Previous Back to top Next FiguresReferencesRelatedDetailsCited By Uygur B, Turkvatan Cansever A, Demir A, Kahraman S, Guner A, Sahin A, Topel C, Celik O, Yildiz M and Erturk M (2021) Detection of a rare cause of pulmonary hypertension by multimodality imaging: Left ventricular endomyocardial fibrosis, Journal of Clinical Ultrasound, 10.1002/jcu.23003, 49:5, (520-524), Online publication date: 1-Jun-2021. Leiner T, Bogaert J, Friedrich M, Mohiaddin R, Muthurangu V, Myerson S, Powell A, Raman S and Pennell D (2020) SCMR Position Paper (2020) on clinical indications for cardiovascular magnetic resonance, Journal of Cardiovascular Magnetic Resonance, 10.1186/s12968-020-00682-4, 22:1, Online publication date: 1-Dec-2020. de Carvalho F and Azevedo C (2020) Comprehensive Assessment of Endomyocardial Fibrosis with Cardiac MRI: Morphology, Function, and Tissue Characterization, RadioGraphics, 10.1148/rg.2020190148, 40:2, (336-353), Online publication date: 1-Mar-2020. Habib G, Bucciarelli-Ducci C, Caforio A, Cardim N, Charron P, Cosyns B, Dehaene A, Derumeaux G, Donal E, Dweck M, Edvardsen T, Erba P, Ernande L, Gaemperli O, Galderisi M, Grapsa J, Jacquier A, Klingel K, Lancellotti P, Neglia D, Pepe A, Perrone-Filardi P, Petersen S, Plein S, Popescu B, Reant P, Sade L, Salaun E, Slart R, Tribouilloy C, Zamorano J, Delgado V, Haugaa K and Vijayaraghavan G (2017) Multimodality Imaging in Restrictive Cardiomyopathies: An EACVI expert consensus document In collaboration with the "Working Group on myocardial and pericardial diseases" of the European Society of Cardiology Endorsed by The Indian Academy of Echocardiography, European Heart Journal - Cardiovascular Imaging, 10.1093/ehjci/jex034, 18:10, (1090-1121), Online publication date: 1-Oct-2017. Mavrogeni S, Sfikakis P, Kitas G, Kolovou G and Tektonidou M (2016) Cardiac involvement in antiphospholipid syndrome: The diagnostic role of noninvasive cardiac imaging, Seminars in Arthritis and Rheumatism, 10.1016/j.semarthrit.2015.09.005, 45:5, (611-616), Online publication date: 1-Apr-2016. Maemura S, Amiya E, Seki H, Ueda K, Nitta D, Imamura T, Uehara M, Kawata T, Watanabe M, Hatano M, Kinugawa K and Komuro I (2016) Endomyocardial Fibrosis Associated With Apical Calcification and High Uptake on Myocardial Gallium-67 Scintigraphy, Circulation Journal, 10.1253/circj.CJ-16-0512, 80:9, (2053-2055), . Mocumbi A and Falase A (2013) Republished: Recent advances in the epidemiology, diagnosis and treatment of endomyocardial fibrosis in Africa, Postgraduate Medical Journal, 10.1136/postgradmedj-2012-303193rep, 90:1059, (48-54), Online publication date: 1-Jan-2014. Fiore A, Grande A, Pellegrini C, Viganò M and Massetti M (2013) Long-Term Survival Following Surgery for Endomyocardial Fibrosis, Journal of Cardiac Surgery, 10.1111/jocs.12159, 28:6, (675-676), Online publication date: 1-Nov-2013. Mocumbi A and Falase A (2013) Recent advances in the epidemiology, diagnosis and treatment of endomyocardial fibrosis in Africa, Heart, 10.1136/heartjnl-2012-303193, 99:20, (1481-1487), Online publication date: 15-Oct-2013. Tuo G, Khambadkone S, Tann O, Kostolny M, Derrick G, Tsang V, Sullivan I and Marek J (2013) Obstructive Left Heart Disease in Neonates With a "Borderline" Left Ventricle: Diagnostic Challenges to Choosing the Best Outcome, Pediatric Cardiology, 10.1007/s00246-013-0685-5, 34:7, (1567-1576), Online publication date: 1-Oct-2013. Caudron J, Arous Y, Fares J, Lefebvre V and Dacher J (2012) Fibrose endomyocardique dans le cadre d'un syndrome hyperéosinophilique : apport de l'IRM cardiaque, Journal de Radiologie Diagnostique et Interventionnelle, 10.1016/j.jradio.2011.07.023, 93:10, (838-840), Online publication date: 1-Oct-2012. Caudron J, Arous Y, Fares J, Lefebvre V and Dacher J (2012) Endomyocardial fibrosis in the context of hypereosinophilic syndrome: The contribution of cardiac MRI, Diagnostic and Interventional Imaging, 10.1016/j.diii.2012.04.019, 93:10, (790-792), Online publication date: 1-Oct-2012. Chauvaud S (2012) Fibrose endomyocardique : traitement chirurgical, EMC - Techniques chirurgicales - Thorax, 10.1016/S1241-8226(12)58679-2, 7:3, (1-7), Online publication date: 1-Sep-2012. Salemi V, Rochitte C, Shiozaki A, Andrade J, Parga J, de Ávila L, Benvenuti L, Cestari I, Picard M, Kim R and Mady C (2011) Late Gadolinium Enhancement Magnetic Resonance Imaging in the Diagnosis and Prognosis of Endomyocardial Fibrosis Patients, Circulation: Cardiovascular Imaging, 4:3, (304-311), Online publication date: 1-May-2011. Germain P, El Ghannudi-Abdo S, Crimizade U and Jeung M (2011) IRM des cardiomyopathies restrictives Imagerie en coupes du cœur et des vaisseaux, 10.1007/978-2-8178-0212-1_6, (57-73), . Robinson J, del Nido P, Geggel R, Perez-Atayde A, Lock J and Powell A (2010) Left Ventricular Diastolic Heart Failure in Teenagers Who Underwent Balloon Aortic Valvuloplasty in Early Infancy, The American Journal of Cardiology, 10.1016/j.amjcard.2010.03.045, 106:3, (426-429), Online publication date: 1-Aug-2010. Benveniste M, Truong M, Almeida D and Szarf G (2010) Endomyocardial fibrosis mimicking right ventricular mass, European Journal of Radiology Extra, 10.1016/j.ejrex.2009.09.001, 73:1, (e9-e11), Online publication date: 1-Jan-2010. Friedrich M (2010) Cardiomyopathies Cardiovascular Magnetic Resonance, 10.1016/B978-0-443-06686-3.00038-2, (515-531), . O'Hanlon R and Pennell D (2009) Cardiovascular Magnetic Resonance in the Evaluation of Hypertrophic and Infiltrative Cardiomyopathies, Heart Failure Clinics, 10.1016/j.hfc.2009.02.003, 5:3, (369-387), Online publication date: 1-Jul-2009. Diaz R, Aranguiz E and Pedemonte O (2009) Complementary Roles of Transthoracic Two-Dimensional Color Doppler Imaging and Myocardial Contrast Echocardiography in Diagnosis of Endomyocardial Fibrosis, Echocardiography, 10.1111/j.1540-8175.2008.00847.x, 26:5, (589-592), Online publication date: 1-May-2009. Houser S (2009) Congenital Heart Disease and Surgical Footprints The Operated Heart at Autopsy, 10.1007/978-1-60327-808-9_6, (123-163), . Vaidyanathan K, Venkatraman R, Sankar M and Cherian K (2008) Endomyocardial Fibrosis in an Adult Mimicking Left Ventricular Mass, The Annals of Thoracic Surgery, 10.1016/j.athoracsur.2008.02.048, 86:3, (1004-1006), Online publication date: 1-Sep-2008. Keeble W, VonderMuhll I and Paterson I (2008) Biventricular apical thrombi demonstrated by contrast-enhanced cardiac MRI following anteroapical STEMI and unsuccessful reperfusion therapy, Canadian Journal of Cardiology, 10.1016/S0828-282X(08)70655-X, 24:8, (S51-S53), Online publication date: 1-Aug-2008. Ordovás K, Reddy G and Higgins C (2008) MRI in nonischemic acquired heart disease, Journal of Magnetic Resonance Imaging, 10.1002/jmri.21172, 27:6, (1195-1213) Aissi K, Rossi P, Le T, Granel B, Bagnères D, Demoux A, Bonin-Guillaume S, Costello R, Sebahoun G and Francès Y (2006) Myocardite nécrosante révélant une leucémie aiguë lymphoblastique hyperéosinophilique, La Revue de Médecine Interne, 10.1016/j.revmed.2006.07.018, 27:11, (869-873), Online publication date: 1-Nov-2006. Bouldouyre M, Bienvenu B, Rollot-Trad F, Blanche P, Vignaux O and Guillevin L (2006) Imagerie par résonance magnétique d'une fibrose endomyocardique, La Presse Médicale, 10.1016/S0755-4982(06)74839-4, 35:10, (1482-1483), Online publication date: 1-Oct-2006. March 8, 2005Vol 111, Issue 9 Advertisement Article InformationMetrics https://doi.org/10.1161/01.CIR.0000157399.96408.36PMID: 15753221 Originally publishedMarch 8, 2005 PDF download Advertisement SubjectsComputerized Tomography (CT)