title: Multiparametric cardiac magnetic resonance imaging (CMR) for the diagnosis of Loeffler's endocarditis: a case report.
abstract: Endocarditis parietalis fibroplastica Löfflein (EPF) is a rare form of primary restrictive cardiomyopathy with poor prognosis. It is generally caused by hypereosinophilic syndrome with eosinophilic penetration of the heart. This leads to congestive heart failure in three different stages. As a frequent manifestation of neoplastic diseases, cardiac involvement means poor prognosis.
  
  
  
  The present report deals with a case of EPF caused by non-specified T-cell lymphoma (T-NOS). Besides an elevated Troponin-T enzyme, the electrocardiogram and the transthoracic echocardiography did not show any characteristic results. Due to risk/benefit assessment and low thrombocyte amounts, endomyocardial biopsy and catheterization were discarded. Using cardiovascular magnetic resonance (CMR) with steady-state free precession sequences, T2-mappping, strain analysis and late gadolinium enhancement, we were able to clearly highlight cardiac involvement at different stages. These findings characterized T-NOS as a palliative situation.
  
  
  
  Multiparametric CMR can not only identify EPF but also characterize the patchy disease state. This provides an individual prognosis assessment. Aside from prognosis estimation, it can also be used for therapy monitoring.
authors.affiliation: Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany. Mareike.Gastl@med.uni-duesseldorf.de.
authors.forename: Mareike
authors.identifier: 0000-0002-7854-8418
authors.initials: M
authors.lastname: Gastl
authors.affiliation: Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: Patrick
authors.initials: P
authors.lastname: Behm
authors.affiliation: Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Jacoby
authors.affiliation: Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: Malte
authors.initials: M
authors.lastname: Kelm
authors.affiliation: Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Bönner
mesh_terms: D000328:Adult; D003287:Contrast Media / Q000008:administration & dosage; D006338:Heart Neoplasms / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D006801:Humans; D017681:Hypereosinophilic Syndrome / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000209:etiology; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D016399:Lymphoma, T-Cell / Q000150:complications / Q000000981:diagnostic imaging* / Q000628:therapy; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D011237:Predictive Value of Tests; D016896:Treatment Outcome
chemical_list: D003287:Contrast Media; D007166:Immunosuppressive Agents
keywords: CMR; Case report; Fibrosis; Heart failure; Hypereosinophilic syndrome; Loeffler’s endocarditis; Restrictive cardiomyopathy