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Eosinophilic 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.

There is limited information on the incidence of eosinophilic endocarditis.

  • the majority of those affected with idiopathic hypereosinophilic syndrome are male (estimated ~90%) 7

Eosinophilic endocarditis results from eosinophilic inflammatory infiltration of the ventricular endocardium. The inflammatory process eventually leads to local necrosis and endomyocardial fibrosis 7.

Intraventricular thrombus commonly forms as a result and often contributes to heart failure by impairing diastolic filling and ventricular function 7.

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
    • majority of cases advanced dysfunction, typically grade III, formerly known as the "restrictive filling" profile
      • early, incidentally detected cases may have lesser degrees of dysfunction
    • pulsed wave Doppler (mitral inflow) and tissue Doppler (mitral annuli) demonstrate:
      • an E/A ratio > 2
      • a deceleration time (DT) < 160 ms 
      • a septal e' < 8 cm/s
      • an LVEDP (septal E/e') > 15

Features which are specific to hypereosinophilic syndrome include 9:

  • left ventricular apical obliteration by laminar thrombosis
  • 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

It is named after Swiss physician, Wilhelm Löffler (1887-1972) 6.

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Article information

rID: 37066
System: Cardiac
Section: Syndromes
Synonyms or Alternate Spellings:
  • Loeffler endocarditis
  • Eosinophillic endocarditis
  • Loeffler's endocarditis
  • Eosinophilic endocarditis

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