Diverse Clinical Presentations of Biventricular Endomyocardial Fibrosis: A Case Series

Endomyocardial fibrosis (EMF), also known as Davies’ disease, is an idiopathic disorder characterized by progressive fibrotic thickening of the endocardium, resulting in restrictive cardiomyopathy. This case series highlights the disease’s diverse clinical spectrum through two distinct presentations. The first case illustrates a chronic late fibrotic stage, manifesting as restrictive heart failure with severe valvular regurgitation and biatrial enlargement. In contrast, the second case represents an active thrombotic stage involving marked hypereosinophilia, multiple intracardiac thrombi, and systemic embolic events. Multimodal imaging, including echocardiography and cardiac magnetic resonance imaging, was critical for diagnosis, identifying hallmark features such as ventricular apical obliteration and subendocardial late gadolinium enhancement. While management focuses on symptom control and anticoagulation, the prognosis remains generally poor. These cases emphasize that EMF is a progressive condition requiring early recognition to guide stage-specific treatment.