Mocumbi AO et al. (2008) A population study of endomyocardial fibrosis in a rural area of Mozambique. N Engl J Med 359: 43–49

Endomyocardial fibrosis is a devastating disease that causes restrictive cardiomyopathy and, eventually, advanced heart failure. The etiology of endomyocardial fibrosis is poorly understood and treatment options are limited. In response to the lack of epidemiologic data from tropical areas where this disease is endemic, Mocumbi et al. have conducted a large-scale, community-based study of endomyocardial fibrosis in Inharrime—a rural, coastal region of Mozambique.

Random selection of villages, and households within each village, produced a study sample of 1,249 individuals, of whom 1,063 participated in the study (mean age 22.5 years, 57.5% women). Screening for endomyocardial fibrosis—using a portable, battery-operated echocardiograph—revealed endomyocardial fibrosis in 211 individuals (19.8% of the cohort), only 48 of whom (22.7%) reported symptoms. A novel 35-point scoring system classified the disease as mild in 163 people (77.3%), moderate in 39 (18.5%), and severe in 9 individuals (4.3%). Although the majority of cases were biventricular (n = 117; 55.5%), left-sided endomyocardial fibrosis was reported more often than biventricular or right-sided disease among participants >30 years of age (37.2% versus 11.3%, P <0.001). The prevalence of endomyocardial fibrosis was highest among patients aged 10–19 years (28.1%) and men were significantly more likely than women to be affected (23.0% versus 17.5%, P = 0.03).

The authors call for further studies in this population to elucidate the molecular mechanisms of endomyocardial fibrosis, and to help develop approaches to its prevention and treatment.