Loeffler’s Cardiac Syndrome: An In-Depth Review of Pathophysiology, Clinical Manifestations, Diagnostic Strategies, and Management Approaches
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Abstract
Loeffler’s cardiac syndrome, a rare and often severe form of hypereosinophilic syndrome, is characterized by endomyocardial damage and restrictive cardiomyopathy secondary to eosinophilic infiltration and degranulation. This condition progresses through three distinct pathological phases: an acute necrotic stage, a thrombotic stage, and finally, an endomyocardial fibrotic stage, leading to significant cardiac dysfunction. The pathophysiological underpinnings are driven by eosinophil-mediated cytotoxicity, resulting in cardiac inflammation, endomyocardial fibrosis, and subsequent heart failure manifestations.
Clinical presentation varies based on the disease stage, ranging from nonspecific symptoms like fatigue and fever to advanced signs of congestive heart failure, thromboembolic events, or restrictive cardiomyopathy. The diagnosis of Loeffler’s cardiac syndrome requires a high index of suspicion, particularly in patients with persistent eosinophilia, and relies on multimodal imaging techniques, including echocardiography and cardiac magnetic resonance imaging (MRI), coupled with laboratory studies and endomyocardial biopsy when indicated.
Current treatment strategies focus on eosinophil-lowering therapies, including corticosteroids and cytotoxic agents, to prevent progression to irreversible fibrosis. In cases with established cardiac damage, therapeutic options may extend to surgical interventions, heart transplantation, or advanced heart failure management. This review synthesizes the latest insights into the pathophysiology, clinical features, diagnostic approaches, and therapeutic modalities of Loeffler’s cardiac syndrome, emphasizing the importance of early recognition and tailored intervention to optimize patient outcomes.
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References
I. .Dregoesc MI, Iancu AC, Lazar AA, Balanescu S. Hypereosinophilic syndrome with cardiac involvement in a patient with multiple malignancies. Med Ultrason. 2018 Aug 30;20(3):399-400.
II. Gao M, Zhang W, Zhao W, Qin L, Pei F, Zheng Y. Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature. Medicine (Baltimore). 2018 Mar;97(11):e0079.
III. Allderdice C, Marcu C, Kabirdas D. Intracardiac Thrombus in Leukemia: Role of Cardiac Magnetic Resonance Imaging in Eosinophilic Myocarditis. CASE (Phila). 2018 Jun;2(3):114-117.
IV. .Jin X, Ma C, Liu S, Guan Z, Wang Y, Yang J. Cardiac involvements in hypereosinophilia-associated syndrome: Case reports and a little review of the literature. Echocardiography. 2017 Aug;34(8):1242-1246.
V. .Doyen D, Buscot M, Eker A, Dellamonica J. Endomyocardial fibrosis complicating primary hypereosinophilic syndrome. Intensive Care Med. 2018 Dec;44(12):2294-2295.
VI. Boggild AK, Keystone JS, Kain KC. Tropical pulmonary eosinophilia: a case series in a setting of nonendemicity. Clin Infect Dis. 2004 Oct 15;39(8):1123-8.
VII. Farruggia P, D'Angelo P, Acquaviva A, Trizzino A, Tucci F, Cilloni D, Messa F, D'Ambrosio A, Aricò M. Hypereosinophilic syndrome in childhood: clinical and molecular features of two cases. Pediatr Hematol Oncol. 2009 Apr-May;26(3):129-35.
VIII. Hayashi S, Isobe M, Okubo Y, Suzuki J, Yazaki Y, Sekiguchi M. Improvement of eosinophilic heart disease after steroid therapy: successful demonstration by endomyocardial biopsied specimens. Heart Vessels. 1999;14(2):104-8.
IX. Gottdiener JS, Maron BJ, Schooley RT, Harley JB, Roberts WC, Fauci AS. Two-dimensional echocardiographic assessment of the idiopathic hypereosinophilic syndrome. Anatomic basis of mitral regurgitation and peripheral embolization. Circulation. 1983 Mar;67(3):572-8.
X. Alam A, Thampi S, Saba SG, Jermyn R. Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis. Clin Med Insights Case Rep. 2017;10:1179547617723643.
XI. .Polito MV, Hagendorff A, Citro R, Prota C, Silverio A, De Angelis E, Klingel K, Metze M, Stöbe S, Hoffmann KT, Sabri O, Piscione F, Galasso G. Loeffler's Endocarditis: An Integrated Multimodality Approach. J Am Soc Echocardiogr. 2020 Dec;33(12):1427-1441.
XII. Shaper AG, Hutt MS, Coles RM. Necropsy study of endomyocardial fibrosis and rheumatic heart disease in Uganda 1950-1965. Br Heart J. 1968 May;30(3):391-401.
XIII. Syed IS, Martinez MW, Feng DL, Glockner JF. Cardiac magnetic resonance imaging of eosinophilic endomyocardial disease. Int J Cardiol. 2008 Jun 06;126(3):e50-2.
XIV. Salemi VM, Rochitte CE, Shiozaki AA, Andrade JM, Parga JR, de Ávila LF, Benvenuti LA, Cestari IN, Picard MH, Kim RJ, Mady C. Late gadolinium enhancement magnetic resonance imaging in the diagnosis and prognosis of endomyocardial fibrosis patients. Circ Cardiovasc Imaging. 2011 May;4(3):304-11.
XV. .Wright BL, Leiferman KM, Gleich GJ. Eosinophil granule protein localization in eosinophilic endomyocardial disease. N Engl J Med. 2011 Jul 14;365(2):187-8.