Loeffler endocarditis

Eosinophilic endocarditis, also known as Loeffler endocarditis, is one of the cardiac manifestations of idiopathic hypereosinophilic syndrome. It also considered a form of cardiomyopathy.

Epidemiology

There is limited information on the incidence of eosinophilic endocarditis.

• the majority of those affected with idiopathic hypereosinophilic syndrome are male (estimated ~90%)

Pathology

Eosinophilic endocarditis results from eosinophilic inflammatory infiltration of the ventricular endocardium. The inflammatory process eventually leads to local necrosis and endomyocardial fibrosis .

Intraventricular thrombus commonly forms as a result and often contributes to heart failure by impairing diastolic filling and ventricular function .

Radiographic features

Echocardiography

Improved detection is impacted by the use of a multi-modality investigation, including the use of transesophageal echocardiography and contrast agents. The standard transthoracic echocardiogram will typically reveal the following features, which are characteristic of the restrictive cardiomyopathies:

• normal left ventricular systolic function
• normal LV cavity dimensions
• diastolic dysfunction
• biatrial dilation

Features which are specific to hypereosinophilic syndrome include :

• left ventricular apical obliteration by laminar thrombosis
  • diffuse and echogenic thrombus
  • occurs in the absence of regional wall motion abnormalities
    • the key distinction from the far more common apical thrombosis due to e.g. ischemic heart disease and subsequent apical dyskinesis
• thickening and increased echogenicity of subendocardial structures
  • preferential involvement of the left ventricular posterobasal (inferolateral) wall and posterior leaflet of mitral valve
  • consequently restricted excursion of mitral valve's posterior leaflet
• eccentric mitral regurgitation

History and etymology

It is named after Swiss physician, Wilhelm Löffler (1887-1972) .

See also

• endomyocardial fibrosis