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Volume 18 Supplement 1

19th Annual SCMR Scientific Sessions

  • Poster presentation
  • Open Access

Retrospective analysis of MR imaging characteristics and demographic characteristics of Tropical Endomyocardial fibrosis in a tertiary care centre in South India

  • 1
Journal of Cardiovascular Magnetic Resonance201618 (Suppl 1) :P286

https://doi.org/10.1186/1532-429X-18-S1-P286

  • Published:

Keywords

  • Right Ventricular
  • Pulmonary Arterial Hypertension
  • Hypertrophic Cardiomyopathy
  • Constrictive Pericarditis
  • Endomyocardial Fibrosis

Background

Cardiac MR is helpful in the diagnosis and prognosis of endomyocardial fibrosis[EMF]. Among the two types of endomyocardial fibrosis, tropical endomyocardial fibrosis is geographically restricted to tropical parts of Africa, Latin America and in the southern districts of India, especially along the coastal region of Kerala. Various toxic and environmental factors were postulated as the etiopathogenesis of tropical endomyocardial fibrosis.

Endomyocardial fibrotic wall thickening of apex and subvalvular regions of one or both ventricles results in restrictive pattern. Typical delayed enhancement pattern is the subendocardial enhancement which is prominent in the apex and extending up to the subvalvular regions

Methods

This study was done in a tertiary care centre in South India. 7 year retrospective analysis of all the cases of endomyocardial fibrosis, which were diagnosed on MRI were included in the study. Retrospective analysis was done using the search tool option in the RIS-PACS software provided by GE. Demographic characteristics, MRI findings and other associated findings were tabulated.

Results

A total of 11 cases were found, of which 9 were females and 2 were males. Most of the patients were young [less than 40 years]. The socio economic status showed mixed pattern, some (~2) from higher socioeconomic status and others from low to middle socioeconomic status. Place of living also was distributed between various states in Indian subcontinent, and didn't pertain to any costal belt. None of the patients had eosinophilia.

Among the MRI findings, 3 patients had only left ventricular (LV) involvement, 3 patients had only right ventricular (RV) involvement, rest had biventricular involvement with RV involvement more than left ventricle involvement in 4 of them. Subendocardial enhancement was present in all. Two patients had associated mid myocardial enhancement in same or different chambers, hence a possibility of associated hypertrophic cardiomyopathy was also raised. Hypokinesia was present in the involved areas in 8 of the patients. Pulmonary arterial hypertension was seen in 5 patients. Thrombus was present in 2 patients. Associated cardiac cirrhosis was noted in 4 patients. One patient had tuberculous constrictive pericarditis and had underwent pericardial stripping . Presence of calcification was identified in 2 patients, who had additional CT sections. Most of the patients had normal LV systolic function. All the patients underwent medical management.

Conclusions

1. Apical obliteration with subendocardial enhancement is typical MRI finding

2. MRI findings can mimic Ebstine's anomaly, however subendocardial enhancement will give the diagnostic clue to EMF.

3. Presence of thrombus due to relative ventricular stasis is also common in EMF.

4. Absence of eosinophilia in the tropical EMF. Postulation of combination of factors leading to EMF may be hypothesized in our case series in view of variation in place of living among patients.

Table 1

Sl No

Place of living

Age

sex

Presence of eosinophilia

Chambers involved

Chambers dilated

Enhancement pattern

Regional wall motion Abnormality

Presence of Pulmonary arterial hypertension

Ejection fraction[LV]

Calcification present

Associated Abnormalities

1

Tamilnadu[TN]

43

M

No

LV

LA, LV

subendocardial

Present

Absent

normal

yes

nil

2

Andhrapradhesh[AP]

34

F

No

LV

LV

subendocardial

Present

Absent

normal

no

nil

3

TN

62

F

No

RV>LV

RA

subendocardial

Present

Present

normal

no

thrombus in RV, cardiac cirrhosis

4

West Bengal

40

F

No

LV

RA, LA

subendocardial, midmyocardial

Absent

Present

normal

no

cardiac cirrhosis

5

TN

27

F

No

RV>LV

RA

subendocardial

Absent

Absent

normal

yes

thrombus in RA, LV,cardiac cirrhosis

6

Bihar

43

F

No

RV>LV

RA

subendocardial, midmyocardial

Present

Absent

normal

no

nil

7

Pondicherry

51

F

No

RV>LV

RA

subendocardial

Present

Absent

reduced

no

nil

8

Bihar

30

F

No

RV

RA

subendocardial

Absent

Absent

normal

no

cardiac cirrhosis

9

AP

23

M

No

LV>RV

RA

subendocardial

Absent

Present

normal

no

Tuberculous constrictive pericarditis

10

Jharkhand

32

F

No

RV

RA

subendocardial

Absent

Present

normal

no

nil

11

TN

61

F

No

RV

RA

subendocardial

Present

Present

normal

no

nil

Figure 1
Figure 1

a) Four chamber view shows RV apex obliteration due to wall thickening [white arrow] and presence of thrombus[black arrow] in dilated right atrium b) Post gadolinium PSIR image shows subendocardial enhancement [white arrow].

Authors’ Affiliations

(1)
Radiology, Chrisitian Medical College, Vellore, India

Copyright

© Leena 2016

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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