Eosinophilic endocarditis

Last revised by Rohit Sharma on 15 Feb 2022

Eosinophilic endocarditis, also known as Löffler (Loeffler) endocarditis, is one of the cardiac manifestations of idiopathic hypereosinophilic syndrome. It is 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:

Features that 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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