Abstract:
Background Endomyocardial fibrosis is the most common restrictive cardiomyopathy worldwide.
It has no specific treatment and carries a poor prognosis, since most patients present
with advanced heart failure. On the basis of clinical series, regional variations in
distribution have been reported within several countries in Africa, Asia, and South
America, but large-scale data are lacking on the epidemiologic features and early
stages of the disease.
We used transthoracic echocardiography to determine the prevalence of endomyo-
cardial fibrosis in a rural area of Mozambique. We screened a random sample of
1063 subjects of all age groups selected by clustering. Major and minor diagnostic
criteria were defined, and a severity score was developed and applied. Cases were
classified according to the distribution and severity of the lesions in the heart.Results
The estimated overall prevalence of endomyocardial fibrosis was 19.8%, or 211 of
1063 subjects (95% confidence interval [CI], 17.4 to 22.2). The prevalence was high-
est among persons 10 to 19 years of age (28.1%, or 73 of 260 subjects [95% CI, 22.6
to 33.6]) and was higher among male than among female subjects (23.0% vs. 17.5%,
P = 0.03). The most common form was biventricular endomyocardial fibrosis (a preva-
lence of 55.5%, or 117 of 211 subjects [95% CI, 48.8 to 62.2]), followed by right-
sided endomyocardial fibrosis (a prevalence of 28.0%, or 59 of 211 subjects [95%
CI, 21.9 to 34.1]). Most affected subjects had mild-to-moderate structural and func-
tional echocardiographic abnormalities. Only 48 persons with endomyocardial fi-
brosis (22.7%) were symptomatic. The frequency of familial occurrence was high.
Endomyocardial fibrosis is common in a rural area of Mozambique. By using echo
cardiography, we were able to detect early, asymptomatic stages of the disease.
These findings may aid in the study of the pathogenesis of the disease and in the
development of new management strategies.
