Skip to main content
British Heart Journal logoLink to British Heart Journal
. 1977 Apr;39(4):399–413. doi: 10.1136/hrt.39.4.399

Primary restrictive cardiomyopathy. Non-tropical endomyocardial fibrosis and hypereosinophilic heart disease.

C Y Chew, G M Ziady, M J Raphael, M Nellen, C M Oakley
PMCID: PMC483251  PMID: 869976

Abstract

Eleven patients with a restrictive cardiomyopathy are described. Seven of these had biventricular disease and in them the haemodynamic abnormality resembled that in constrictive pericarditis but the condition was distinguishable because of unequal involvement of the two ventricles, murmurs of atrioventricular valve regurgitation, or characteristic ventricular deformity on angiography. Two of these patients had eosinophilia with the clinical features of Löffer's endocarditis. In 4 patients the disease was apparently confined to the left ventricle; they were investigated on account of atypical chest pain, third heart sound, or abnormal electrocardiogram. Simultaneous measurements of left ventricular pressure and volume throughout diastole were made in 3 patients and showed rapid but abruptly curtailed left ventricular filling. Transvenous endomyocardial biopsy in 2 patients showed fibrous tissue with collagen and irregular elastic fibrils. Surgical biopsy in 3 patients excluded pericardial constriction but was diagnostically unhelpful because of failure to obtain endocardium. Necropsy in one patient showed that the heart had features indistinguishable from tropical endomyocardial fibrosis. It is suggested that the spectrum of ventricular abnormalities in these patients results from endomyocardial fibrosis of varying severity and probably of differing cause. This study has shown that "tropical" endomyocardial fibrosis may occur outside the tropics and suggests that eosinophilia may play a leading role or associated part in the genesis of some cases.

Full text

PDF
399

Images in this article

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. ANDRADE Z. A., GUIMARAES A. C. ENDOMYOCARDIAL FIBROSIS IN BAHIA, BRAZIL. Br Heart J. 1964 Nov;26:813–820. doi: 10.1136/hrt.26.6.813. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. ARCHER R. K. ON THE FUNCTIONS OF EOSINOPHILS IN THE ANTIGEN-ANTIBODY REACTION. Br J Haematol. 1965 Mar;11:123–129. doi: 10.1111/j.1365-2141.1965.tb06570.x. [DOI] [PubMed] [Google Scholar]
  3. ARNOTT W. M. A problem in tropical cardiology. Br Med J. 1959 Dec 12;2(5162):1273–1277. doi: 10.1136/bmj.2.5162.1273. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. BALL J. D., WILLIAMS A. W., DAVIES J. N. Endomyocardial fibrosis. Lancet. 1954 May 22;266(6821):1049–1054. doi: 10.1016/s0140-6736(54)91619-0. [DOI] [PubMed] [Google Scholar]
  5. BLACK M., FOWLER J. M. ENDOMYOCARDIAL FIBROSIS IN BRITAIN. Br Med J. 1965 Mar 13;1(5436):682–686. doi: 10.1136/bmj.1.5436.682. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. BRINK A. J., WEBER H. W. Fibroplastic parietal endocarditis with eosinophilia. Loffler's endocarditis. Am J Med. 1963 Jan;34:52–70. doi: 10.1016/0002-9343(63)90038-x. [DOI] [PubMed] [Google Scholar]
  7. Bana D. S., MacNeal P. S., LeCompte P. M., Shah Y., Graham J. R. Cardiac murmurs and endocardial fibrosis associated with methysergide therapy. Am Heart J. 1974 Nov;88(5):640–655. doi: 10.1016/0002-8703(74)90251-8. [DOI] [PubMed] [Google Scholar]
  8. Bell J. A., Jenkins B. S., Webb-Peploe M. M. Clinical, haemodynamic, and angiographic findings in Löffler's eosinophilic endocarditis. Br Heart J. 1976 Jun;38(6):541–548. doi: 10.1136/hrt.38.6.541. [DOI] [PMC free article] [PubMed] [Google Scholar]
  9. Bertrand E., Renambot J., Chauvet J., Le Bras M., Lamouche P., Ekra A., Roux F., Ette M., Loubière R. Sur 14 cas de fibrose endocardique constrictive (ou fibrose endo-myocardiuqe) Arch Mal Coeur Vaiss. 1975 Jun;68(6):625–635. [PubMed] [Google Scholar]
  10. Bishop M. B., Bousvaros G., Cunningham T. J., Jain A. C., Davies J. N. Endomyocardial fibrosis in a North American Negro. Probable familial incidence. Lancet. 1968 Oct 5;2(7571):750–751. doi: 10.1016/s0140-6736(68)90951-3. [DOI] [PubMed] [Google Scholar]
  11. CLARK G. M., VALENTINE E., BLOUNT S. G., Jr Endocardial fibrosis simulating constrictive pericarditis; report of a case with determinations of pressure in the right side of the heart and eosinophilia. N Engl J Med. 1956 Feb 23;254(8):349–355. doi: 10.1056/NEJM195602232540801. [DOI] [PubMed] [Google Scholar]
  12. COELHO E., PIMENTEL J. C. DIFFUSE ENDOMYOCARDIAL FIBROSIS. Am J Med. 1963 Oct;35:569–576. doi: 10.1016/0002-9343(63)90155-4. [DOI] [PubMed] [Google Scholar]
  13. Chew C., Ziady G. M., Raphael M. J., Oakley C. M. The functional defect in amyloid heart disease. The "stiff heart" syndrome. Am J Cardiol. 1975 Oct 6;36(4):438–444. doi: 10.1016/0002-9149(75)90891-7. [DOI] [PubMed] [Google Scholar]
  14. Chusid M. J., Dale D. C., West B. C., Wolff S. M. The hypereosinophilic syndrome: analysis of fourteen cases with review of the literature. Medicine (Baltimore) 1975 Jan;54(1):1–27. [PubMed] [Google Scholar]
  15. Cockshott W. P., Sarić S., Ikeme A. C. Radiological findings in endomyocardial fibrosis. Circulation. 1967 May;35(5):913–922. doi: 10.1161/01.cir.35.5.913. [DOI] [PubMed] [Google Scholar]
  16. Connor D. H., Somers K., Hutt M. S., Manion W. C., D'Arbela P. G. Endomyocardial fibrosis in Uganda (Davies' disease). 1. An epidemiologic, clinical, and pathologic study. Am Heart J. 1967 Nov;74(5):687–709. doi: 10.1016/0002-8703(67)90509-1. [DOI] [PubMed] [Google Scholar]
  17. Connor D. H., Somers K., Hutt M. S., Manion W. C., D'Arbela P. G. Endomyocardial fibrosis in Uganda (Davies' disease). II. An epidemiologic, clinical, and pathologic study. Am Heart J. 1968 Jan;75(1):107–124. doi: 10.1016/0002-8703(68)90122-1. [DOI] [PubMed] [Google Scholar]
  18. Contreras R., Bialostozky D., Medrano G., Fishleder B., Guadalajara J. F. Fibrosis endomiocárdica Africana o tropical. Comunicación del primer caso observado en México. Arch Inst Cardiol Mex. 1971 Jul-Aug;41(4):476–489. [PubMed] [Google Scholar]
  19. D'Arbela P. G., Mutazindwa T., Patel A. K., Somers K. Survival after first presentation with endomyocardial fibrosis. Br Heart J. 1972 Apr;34(4):403–407. doi: 10.1136/hrt.34.4.403. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Davies H., Deuchar D. C., Missen G. A. Endomyocardial fibrosis: two cases with severe pulmonary hypertension presenting in England. Guys Hosp Rep. 1965;114(4):337–362. [PubMed] [Google Scholar]
  21. Davies J. N. The ridge in endomyocardial fibrosis. Lancet. 1968 Mar 23;1(7543):631–632. doi: 10.1016/s0140-6736(68)91250-6. [DOI] [PubMed] [Google Scholar]
  22. FARUQUE A. A. ADULT ENDOMYOCARDIAL FIBROSIS IN BRITAIN. Lancet. 1963 Aug 17;2(7303):331–333. doi: 10.1016/s0140-6736(63)92995-7. [DOI] [PubMed] [Google Scholar]
  23. Frenkel R., Grieco M., Garret R. Löfflers endomyocarditis associated with bronchial asthma and eosinophilia. Ann Allergy. 1975 Apr;34(4):213–218. [PubMed] [Google Scholar]
  24. Goodwin J. F., Oakley C. M. The cardiomyopathies. Br Heart J. 1972 Jun;34(6):545–552. doi: 10.1136/hrt.34.6.545. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Guimarães A. C., Santos Filho A., Esteves J. P., Vinhaes L. S., Abreu W. N. Hemodynamics in endomyocardial fibrosis. Am Heart J. 1974 Sep;88(3):294–303. doi: 10.1016/0002-8703(74)90462-1. [DOI] [PubMed] [Google Scholar]
  26. Ive F. A., Willis A. J., Ikeme A. C., Brockington I. F. Endomyocardial fibrosis and filariasis. Q J Med. 1967 Oct;36(144):495–516. [PubMed] [Google Scholar]
  27. Kasser I. S., Kennedy J. W. Measurement of left ventricular volumes in man by single-plane cineangiocardiography. Invest Radiol. 1969 Mar-Apr;4(2):83–90. doi: 10.1097/00004424-196904020-00005. [DOI] [PubMed] [Google Scholar]
  28. LITT M. STUDIES IN EXPERIMENTAL EOSINOPHILIA. VI. UPTAKE OF IMMUNE COMPLEXES BY EOSINOPHILS. J Cell Biol. 1964 Nov;23:355–361. doi: 10.1083/jcb.23.2.355. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. LYNCH J. B., WATT J. Diffuse endomyocardial sclerosis. Br Heart J. 1957 Apr;19(2):173–185. doi: 10.1136/hrt.19.2.173. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Lachmann P. J., Kay A. B., Thompson R. A. The chemotactic activity for neutrophil and eosinophil leucocytes of the trimolecular complex of the fifth, sixth and seventh components of human complement (C567) prepared in free solution by the 'reactive lysis' procedure. Immunology. 1970 Dec;19(6):895–899. [PMC free article] [PubMed] [Google Scholar]
  31. Lepley D., Jr, Aris A., Korns M. E., Walker J. A., D'Cunha R. M. Endomyocardial fibrosis. A surgical approach. Ann Thorac Surg. 1974 Dec;18(6):626–633. doi: 10.1016/s0003-4975(10)64411-6. [DOI] [PubMed] [Google Scholar]
  32. Libanoff A. J., McMahon N. J. Eosinophilia and endomyocardial fibrosis. Am J Cardiol. 1976 Mar 4;37(3):438–441. doi: 10.1016/0002-9149(76)90296-4. [DOI] [PubMed] [Google Scholar]
  33. McKUSICK V. A., COCHRAN T. H. Constrictive endocarditis; report of a case. Bull Johns Hopkins Hosp. 1952 Jan;90(1):90–97. [PubMed] [Google Scholar]
  34. McNAMARA P. J., JACOBS W. H., JAFFE R. J. Idiopathic cardiac hypertrophy with endomyocardial fibrosis: report of a case developing after recovery from a purulent lung abscess. Ann Intern Med. 1959 Apr;50(4):1035–1045. doi: 10.7326/0003-4819-50-4-1035. [DOI] [PubMed] [Google Scholar]
  35. NAGARATNAM N., DISSANAYAKE R. V. Endomyocardial fibrosis in the Ceylonese. Br Heart J. 1959 Apr;21(2):167–173. doi: 10.1136/hrt.21.2.167. [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. NAKAJIMA K., OKADA R., UEDA H. A case report of endomyocardial fibrosis. Jpn Heart J. 1961 Apr;2:265–275. doi: 10.1536/ihj.2.265. [DOI] [PubMed] [Google Scholar]
  37. Oakley C. M., Olsen G. J. Eosinophilia and heart disease. Br Heart J. 1977 Mar;39(3):233–237. doi: 10.1136/hrt.39.3.233. [DOI] [PMC free article] [PubMed] [Google Scholar]
  38. Oakley C. M. The relation between function and causation in cardiomyopathy. Postgrad Med J. 1975 May;51(595):271–276. doi: 10.1136/pgmj.51.595.271. [DOI] [PMC free article] [PubMed] [Google Scholar]
  39. Olsen E. G. Pathological recognition of cardiomyopathy. Postgrad Med J. 1975 May;51(595):277–281. doi: 10.1136/pgmj.51.595.277. [DOI] [PMC free article] [PubMed] [Google Scholar]
  40. Roberts W. C., Buja L. M., Ferrans V. J. Löffler's fibroplastic parietal endocarditis, eosinophilic leukemia, and Davies' endomyocardial fibrosis: the same disease at different stages? Pathol Microbiol (Basel) 1970;35(1):90–95. doi: 10.1159/000162205. [DOI] [PubMed] [Google Scholar]
  41. Roberts W. C., Liegler D. G., Carbone P. P. Endomyocardial disease and eosinophilia. A clinical and pathologic spectrum. Am J Med. 1969 Jan;46(1):28–42. doi: 10.1016/0002-9343(69)90055-2. [DOI] [PubMed] [Google Scholar]
  42. SABESIN S. M. A function of the eosinophil: phagocytosis of antigen-antibody complexes. Proc Soc Exp Biol Med. 1963 Mar;112:667–670. doi: 10.3181/00379727-112-28134. [DOI] [PubMed] [Google Scholar]
  43. STUART K. L., HAYES J. A. A cardiac disorder of unknown aetiology in Jamaica. Q J Med. 1963 Apr;32:99–114. [PubMed] [Google Scholar]
  44. Scott M. E., Bruce J. H. Löffler's endocarditis. Br Heart J. 1975 May;37(5):534–538. doi: 10.1136/hrt.37.5.534. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Shabetai R., Fowler N. O., Guntheroth W. G. The hemodynamics of cardiac tamponade and constrictive pericarditis. Am J Cardiol. 1970 Nov;26(5):480–489. doi: 10.1016/0002-9149(70)90706-x. [DOI] [PubMed] [Google Scholar]
  46. Shillingford J. P., Somers K. CLINICAL AND HAEMODYNAMIC PATTERNS IN ENDOMYOCARDIAL FIBROSIS. Br Heart J. 1961 Jul;23(4):433–446. doi: 10.1136/hrt.23.4.433. [DOI] [PMC free article] [PubMed] [Google Scholar]
  47. Somers K., Brenton D. P., D'Arbela P. G., Fowler J. M., Kanyerezi B. R., Sood N. K. Haemodynamic features of severe endomyocardial fibrosis of right ventricle, including comparison with constrictive pericarditis. Br Heart J. 1968 May;30(3):322–332. doi: 10.1136/hrt.30.3.322. [DOI] [PMC free article] [PubMed] [Google Scholar]
  48. Spry C. J., Tai P. C. Studies on blood eosinophils. II. Patients with Löffler's cardiomyopathy. Clin Exp Immunol. 1976 Jun;24(3):423–434. [PMC free article] [PubMed] [Google Scholar]
  49. THOMAS W. A., RANDALL R. V., BLAND E. F., CASTLEMAN B. Endocardial fibroelastosis; a factor in heart disease of obscure etiology: a study of 20 autopsied cases in children and adults. N Engl J Med. 1954 Aug 26;251(9):327–338. doi: 10.1056/NEJM195408262510902. [DOI] [PubMed] [Google Scholar]
  50. Van der Hauwaert L. G., Corbeel L., Maldague P. Fibroma of the right ventricle producing severe tricuspid stenosis. Circulation. 1965 Sep;32(3):451–456. doi: 10.1161/01.cir.32.3.451. [DOI] [PubMed] [Google Scholar]
  51. WOOD P. Chronic constrictive pericarditis. Am J Cardiol. 1961 Jan;7:48–61. doi: 10.1016/0002-9149(61)90422-2. [DOI] [PubMed] [Google Scholar]
  52. Weinberger A., Pinkhas J., Sandbank U., Shaklai M., de Vries A. Endocardial fibrosis following busulfan treatment. JAMA. 1975 Feb 3;231(5):495–495. [PubMed] [Google Scholar]
  53. Wilcox R. G., James P. D., Toghill P. J. Endomyocardial fibrosis associated with daunorubicin therapy. Br Heart J. 1976 Aug;38(8):860–863. doi: 10.1136/hrt.38.8.860. [DOI] [PMC free article] [PubMed] [Google Scholar]
  54. YOSHIDA T., NIMURA Y., SAKAKIBARA H., MATSUTANI K., NISHIZAKI K., NAKATA T. A DIFFUSE ENDOCARDIAL FIBROELASTOSIS WITH MARKEDLY DILATED RIGHT ATRIUM OBSERVED IN AN ADULT. Jpn Heart J. 1964 Jan;5:85–92. doi: 10.1536/ihj.5.85. [DOI] [PubMed] [Google Scholar]
  55. van der Geld H., Peetoom F., Somers K., Kanyerezi B. R. Immunohistological and serological studies in endomyocardial fibrosis. Lancet. 1966 Dec 3;2(7475):1210–1213. doi: 10.1016/s0140-6736(66)92300-2. [DOI] [PubMed] [Google Scholar]

Articles from British Heart Journal are provided here courtesy of BMJ Publishing Group

RESOURCES