Overview
Endomyocardial fibrosis (EMF) is a form of restrictive cardiomyopathy characterized by fibrosis of the endocardium and subendocardium of the ventricles 1. This fibrosis impairs both systolic and diastolic function and can lead to ventricular arrhythmias 1.Diagnosis
Cardiac magnetic resonance (CMR) can assess diffuse myocardial fibrosis using native T1 time 1.Management
Eplerenone demonstrated an antifibrotic effect in nonobstructive hypertrophic cardiomyopathy (HCM) by reducing myocardial T1 time 1.
In a trial of nonobstructive HCM, eplerenone (50 mg) was associated with a reduction in native T1 time over 12 months compared to placebo 1.
No significant changes in functional status or markers of diastolic function were observed with eplerenone in this trial 1.Key Recommendations
Eplerenone may reduce diffuse myocardial fibrosis in patients with nonobstructive hypertrophic cardiomyopathy, as indicated by a reduction in native T1 time on cardiac MRI 1. (Evidence: Moderate)
Larger and longer trials are needed to confirm the antifibrotic effects of eplerenone and explore its clinical impact in hypertrophic cardiomyopathy 1. (Evidence: Weak)References
1 Papapostolou S, Iles L, O'Brien J, Gutman SJ, Ellims A, Hare J et al.. The Antifibrotic Effects of Eplerenone in Hypertrophic Cardiomyopathy: A Randomized Clinical Trial. JACC. Heart failure 2025. link