title: Late gadolinium enhancement magnetic resonance imaging in the diagnosis and prognosis of endomyocardial fibrosis patients.
abstract: BACKGROUND
  Endocardial fibrous tissue (FT) deposition is a hallmark of endomyocardial fibrosis (EMF). Echocardiography is a first-line and the standard technique for the diagnosis of this disease. Although late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) allows FT characterization, its role in the diagnosis and prognosis of EMF has not been investigated.
  
  
  RESULTS
  Thirty-six patients (29 women; age, 54±12 years) with EMF diagnosis after clinical evaluation and comprehensive 2-dimensional Doppler echocardiography underwent cine-CMR for assessing ventricular volumes, ejection fraction and mass, and LGE-CMR for FT characterization and quantification. Indexed FT volume (FT/body surface area) was calculated after planimetry of the 8 to 12 slices obtained in the short-axis view at end-diastole (mL/m(2)). Surgical resection of FT was performed in 16 patients. In all patients, areas of LGE were confined to the endocardium, frequently as a continuous streak from the inflow tract extending to the apex, where it was usually most prominent. There was a relation between increased FT/body surface area and worse New York Heart Association functional class and with increased probability of surgery (P<0.05). The histopathologic examination of resected FT showed typical features of EMF with extensive endocardial fibrous thickening, proliferation of small vessels, and scarce inflammatory infiltrate. In multivariate analysis, the patients with FT/body surface area >19 mL/m(2) had an increased mortality rate, with a relative risk of 10.8.
  
  
  CONCLUSIONS
  Our study provides evidence that LGE-CMR is useful in the diagnosis and prognosis of EMF through quantification of the typical pattern of FT deposition.
authors.affiliation: Cardiomyopathy Unit, Heart Institute (InCor) da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
authors.forename: Vera M C
authors.initials: VM
authors.lastname: Salemi
authors.forename: Carlos E
authors.initials: CE
authors.lastname: Rochitte
authors.forename: Afonso A
authors.initials: AA
authors.lastname: Shiozaki
authors.forename: Joalbo M
authors.initials: JM
authors.lastname: Andrade
authors.forename: José R
authors.initials: JR
authors.lastname: Parga
authors.forename: Luiz F
authors.initials: LF
authors.lastname: de Ávila
authors.forename: Luiz A
authors.initials: LA
authors.lastname: Benvenuti
authors.forename: Ismar N
authors.initials: IN
authors.lastname: Cestari
authors.forename: Michael H
authors.initials: MH
authors.lastname: Picard
authors.forename: Raymond J
authors.initials: RJ
authors.lastname: Kim
authors.forename: Charles
authors.initials: C
authors.lastname: Mady
mesh_terms: D000328:Adult; D000368:Aged; D003287:Contrast Media; D004719:Endomyocardial Fibrosis / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000503:physiopathology; D005260:Female; D019786:Gadolinium DTPA; D006333:Heart Failure / Q000150:complications; D006352:Heart Ventricles / Q000473:pathology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D013318:Stroke Volume
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA