Author + information
- Received September 16, 2013
- Revision received October 21, 2013
- Accepted October 21, 2013
- Published online March 1, 2014.
- Martina Perazzolo Marra, MD, PhD∗∗ (, )
- Gaetano Thiene, MD∗,
- Stefania Rizzo, MD, PhD∗,
- Manuel De Lazzari, MD∗,
- Elisa Carturan, PhD∗,
- Francesco Tona, MD, PhD∗,
- Alida Linda Caforio, MD, PhD∗,
- Luisa Cacciavillani, MD, PhD∗,
- Renzo Marcolongo, MD†,
- Giuseppe Tarantini, MD, PhD∗,
- Francesco Corbetti, MD‡,
- Sabino Iliceto, MD∗ and
- Cristina Basso, MD, PhD∗
- ∗Department of Cardiac, Thoracic, and Vascular Sciences, Azienda Ospedaliera–University of Padua Medical School, Padua, Italy
- †Hematology Division, Azienda Ospedaliera–University of Padua Medical School, Padua, Italy
- ‡Radiology Service, Azienda Ospedaliera–University of Padua Medical School, Padua, Italy
- ↵∗Reprint requests and correspondence:
Dr. Martina Perazzolo Marra, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Via Giustiniani, 2 35128 Padua, Italy.
The hypereosinophilic syndrome is characterized by persistent marked eosinophilia (≥1.5 eosinophils × 109/l) and evidence of eosinophil-mediated organ damage. Cardiac involvement due to hypereosinophilic syndrome includes the eosinophilic myocarditis (EM), the Loeffler endocarditis (LE), and the endomyocardial fibrosis (EMF). The pathologic substrates of hypereosinophilic syndrome have been traditionally distinguished into the acute necrotic stage, characterized by active EM; the subacute early stage, characterized by the deposition of mural endocardial thrombi (LE); and the late fibrotic stage, due to the progressive scarring leading to EMF with a restrictive hemodynamic pattern. The diagnosis requires a complex instrumental work-up and endomyocardial biopsy (EMB) has been considered the gold standard. Nowadays, cardiac magnetic resonance (CMR) offers the possibility of a noninvasive myocardial tissue characterization on post-contrast sequences, besides morphofunctional assessment (Fig. 1). In the EM/LE and EMF cases herein reported (Figs. 2 and 3), with follow-up data in 1 of them (Figs. 4 and 5), CMR data are compared with EMB findings, thus proving the capability of CMR to identify myocardial inflammation, mural thrombi, and endocardial fibrosis.
In conclusion, our data support CMR as a diagnostic tool in endomyocardial diseases, as validated by EMB. Serial studies by CMR and EMB confirm that EMF and EM/LE are often different stages of the same disease. The noninvasiveness of CMR emphasizes its role in the follow-up evaluation.
This work was supported by the Registry for Cardio-Cerebro-Vascular-Pathology, Veneto Region, Venice, Italy. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received September 16, 2013.
- Revision received October 21, 2013.
- Accepted October 21, 2013.
- American College of Cardiology Foundation