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Determinants of survival in endomyocardial fibrosis
A C Barretto1, P L da Luz, S A de Oliveira
1Divisão de Clínica, Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo, Brasil.
Insights
Endomyocardial fibrosis impacts 108 patients, with biventricular involvement and heart valve regurgitation linked to higher mortality. Surgical treatment shows a trend toward better outcomes for advanced cases.
Area of Science:
- Cardiology
- Cardiovascular Research
- Fibrosis Studies
Background:
- Endomyocardial fibrosis (EMF) is a rare condition affecting heart muscle.
- Understanding EMF's clinical course and prognostic factors is crucial for patient management.
Purpose of the Study:
- To describe the clinical characteristics and outcomes of 108 patients with endomyocardial fibrosis.
- To identify factors associated with mortality in EMF patients.
Main Methods:
- Retrospective analysis of 108 EMF patients.
- Cardiac catheterization and angiography for assessing biventricular involvement.
- Classification of fibrosis severity and New York Heart Association (NYHA) functional classes.
- Survival analysis comparing clinical and surgical treatments.
Main Results:
- 64% of patients had biventricular involvement; 84% were in NYHA functional classes III/IV.
- Tricuspid and mitral regurgitation were prevalent (58% and 60%, respectively).
- Biventricular involvement, right ventricular fibrosis, and valve regurgitation correlated with increased mortality.
- Surgical treatment trended towards better outcomes in advanced NYHA classes (III/IV).
Conclusions:
- Endomyocardial fibrosis frequently presents with biventricular involvement and significant valvular dysfunction.
- Factors like extent of fibrosis and valve regurgitation are critical determinants of mortality.
- Surgical intervention may offer improved survival for patients with advanced EMF.
Abstract:
This study describes the clinical course of 108 patients with endomyocardial fibrosis. There were 76 females and 32 males, with a mean age of 35 years. All patients underwent cardiac catheterization. The angiographic data show that 64 (59%) patients had biventricular involvement. From a clinical point of view, 91 (84%) were in New York Heart Association functional classes III and IV. According to the right and left ventricular intensity of fibrosis, the patients were classified as mild (40 [37%]), moderate (36 [33%]), or severe (32 [30%]) for the right ventricle and mild (19 [18%]), moderate (61 [56%]), or severe (28 [26%]) for the left ventricle. Tricuspid regurgitation was observed in 63 (58%) patients and mitral regurgitation in 65 (60%) patients. Fifty patients in functional classes III and IV underwent surgical treatment. Survival curves constructed according to functional classes showed better prognosis for those in classes I and II (p = 0.0452). Survival curves for patients in classes III and IV for clinical and surgical treatment showed a trend toward better results for the surgical group. Analysis of factors that may have influenced the course of endomyocardial fibrosis showed that biventricular involvement (moderate or severe), right ventricular fibrosis, and presence of tricuspid and mitral regurgitation were associated with greater mortality.