Cardiac magnetic resonance imaging for the diagnosis of endomyocardial fibrosis.

Endomyocardial fibrosis (EMF) is a common cause of restrictive cardiomyopathy in the tropics and has been underdiagnosed in the past. Sometimes it is difficult to differentiate EMF from other restrictive cardiomyopathies. Cur- rently, echocardiography is used for the initial investigations that might lead to a diagnosis of EMF. In this study, we evaluate the usefulness of cardiac magnetic resonance (CMR) imaging as an alternative noninvasive diagnostic tool. Twenty- eight patients (17 men and 11 women; aged 51.9 +/- 13.5 years), who were diagnosed as having restrictive cardiomyopathy after comprehensive echocardiography, underwent CMR imaging with the standard cardiomyopathy protocol. EMF was diagnosed in seven (25%) of these patients. Five patients with EMF had bi-ventricular involvement and one each had right and left ventricular involvement. Myocardial edema indicating acute inflammation was seen in one (14.3%) patient. Apical thrombus was seen in four (57.1%) cases. Subendocardial delayed enhancement was always present in the involved ventricles. Our results show that CMR imaging with late gadolinium enhancement can clearly detect the common hallmarks of EMF: endocardial fibrous tissue and obliteration of the involved ventricular apex.