A Narrative Review on Endomyocardial Fibrosis: Unraveling an Under-Recognized Tropical Heart Disease

Endomyocardial fibrosis (EMF) is a neglected tropical cardiomyopathy, primarily affecting children and young adults in low-income equatorial regions. Characterized by fibrotic thickening of the ventricular endocardium, EMF leads to restrictive physiology, atrioventricular valve dysfunction, and progressive heart failure. Despite being recognized for over half a century, its etiology remains poorly understood, with proposed contributors including malnutrition, parasitic infections, hypereosinophilia, and genetic predisposition. Diagnosis is often delayed due to overlap with other causes of heart failure and limited access to advanced imaging. Echocardiography remains the primary diagnostic tool, especially in resource-limited settings, while cardiac MRI offers superior tissue characterization. Treatment is largely symptomatic, with diuretics, anticoagulants, and antiarrhythmics offering palliative benefit. Surgical intervention-particularly endocardial decortication and valve repair-remains the definitive treatment for advanced cases, though it carries high operative risk and is often inaccessible. Emerging approaches, such as artificial intelligence (AI)-assisted imaging and radiomics, hold promise for early detection. This narrative review synthesizes current knowledge on EMF's epidemiology, pathophysiology, diagnosis, and management, underscoring the urgent need for improved awareness, research funding, and global health prioritization to mitigate its burden in vulnerable populations.