Author + information
- Received November 11, 2015
- Revision received May 3, 2016
- Accepted May 5, 2016
- Published online September 4, 2017.
- Ahmed ElGuindy, MSc, MDa,
- Ahmed Afifi, MSc, MDb,
- Walid Simry, MScb,
- Soha Romeih, MSc, MD, PhDa and
- Magdi Yacoub, MD, PhDb,c,∗ ()
- aDepartment of Cardiology, Aswan Heart Centre, Aswan, Egypt
- bDepartment of Cardiac Surgery, Aswan Heart Centre, Aswan, Egypt
- cHarefield Heart Science Centre, Imperial College London, Harefield, United Kingdom
- ↵∗Address for correspondence:
Sir Magdi H. Yacoub, Harefield Heart Science Centre, Harefield Hospital, Hill End Road, Harefield, UB9 6JH, United Kingdom.
Endomyocardial fibrosis (EMF) is a global neglected disease, which is more prevalent in tropical and subtropical countries, where it causes considerable morbidity and mortality (1,2). The disease can affect all 4 chambers of the heart as well as the atrioventricular valves. Contrary to prevailing dogma, the myocardium appears to be spared. Currently, there is no effective medical treatment, with surgical “corrective” procedures being the only option for severely symptomatic patients. The results of these operations depend critically on timing and accurate definition of the site, extent, and nature of the pathological process. Modern multimodality imaging offers unique opportunities to answer these questions. Cardiac magnetic resonance in particular is extremely useful in confirming the diagnosis and differentiating EMF from other disease entities that may present similarly (e.g., Ebstein anomaly, tumors, thrombus). Cardiac magnetic resonance is also able to provide valuable information that helps tailor the surgical approach; this includes accurate definition of site(s) and extent of fibrosis, involved structures, degree of splinting of the myocardium, viable myocardial mass (which can help predict recovery of ventricular function after surgery), and ventricular volumes. An illustrated systematic analysis of the varied manifestations of the disease is presented here (Figures 1, 2, and 3).
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received November 11, 2015.
- Revision received May 3, 2016.
- Accepted May 5, 2016.
- 2017 American College of Cardiology Foundation