Ito Shinya, Isotani Akihiro, Yamaji Kyohei, Ando Kenji
Department of Cardiovascular Medicine, Kokura Memorial Hospital, 3-2-1 Asano, Kokurakita-ku, Kitakyushu, Fukuoka 802-8555, Japan.
Eur Heart J Case Rep. 2020 Nov 9;4(6):1-4. doi: 10.1093/ehjcr/ytaa381. eCollection 2020 Dec.
Löffler endocarditis is a condition characterized by cardiac infiltration of eosinophils. Cardiac magnetic resonance imaging (MRI) is a modality for the diagnosis of myocardial damage.
This is the case of a 77-year-old man with acute decompensated heart failure who was admitted. Transthoracic echocardiography showed preserved left ventricular (LV) systolic function along with LV thrombi attached to the septo-apical wall and the posterior wall, consistent with Löffler endocarditis. Cardiac MRI revealed obliteration of the LV apex and partial filling of the LV cavity, as well as near circumferential subendocardial late gadolinium enhancement (LGE) in the mid- and apical segments. T2-weighted images showed a near circumferential high-intensity area of the LV subendocardial muscle in the mid- and apical segments. High-dose corticosteroids and intravenous heparin were initiated, followed by maintenance warfarin therapy. At 18 months, follow-up cardiac MRI revealed the disappearance of the LV thrombi, and a reduction of LGE, as well as high-intensity areas in the T2-weighted images.
The high-intensity area of T2-weighted images indicate the presence of subendocardial oedema. Eosinophil-mediated heart damage evolves through three stages: (i) acute necrotic, (ii) thrombotic, and (iii) fibrotic stages. Since the deposition of toxic eosinophil granule proteins and eosinophil infiltration injured the endocardium, the first-line treatment for Löffler endocarditis is corticosteroid therapy. In this case, LGE in the subendocardium and the high-intensity area in the T2-weighted images were reduced at 18 months. High-intensity areas of T2-weighted images in the acute phase might indicate the possibility of therapeutic response to corticosteroid therapy.
吕弗勒心内膜炎是一种以嗜酸性粒细胞浸润心脏为特征的疾病。心脏磁共振成像（MRI）是诊断心肌损伤的一种方法。
本文报告一例77岁急性失代偿性心力衰竭男性患者。经胸超声心动图显示左心室（LV）收缩功能保留，室间隔心尖壁和后壁附着有LV血栓，符合吕弗勒心内膜炎表现。心脏MRI显示LV心尖闭塞、LV腔部分充盈，以及在心肌中层和心尖段近圆周性心内膜下延迟钆增强（LGE）。T2加权图像显示心肌中层和心尖段LV心内膜下心肌近圆周性高强度区域。开始使用大剂量皮质类固醇和静脉注射肝素，随后维持华法林治疗。18个月时，随访心脏MRI显示LV血栓消失，LGE减少，T2加权图像中的高强度区域也减少。
T2加权图像中的高强度区域表明存在心内膜下水肿。嗜酸性粒细胞介导的心脏损伤通过三个阶段发展：（i）急性坏死阶段，（ii）血栓形成阶段，以及（iii）纤维化阶段。由于有毒嗜酸性粒细胞颗粒蛋白的沉积和嗜酸性粒细胞浸润损伤了心内膜，吕弗勒心内膜炎的一线治疗是皮质类固醇治疗。在本病例中，18个月时心内膜下LGE和T2加权图像中的高强度区域减少。急性期T2加权图像中的高强度区域可能表明对皮质类固醇治疗有治疗反应的可能性。
