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MOGE(S) nosology in low-to-middle-income countries

Nature Reviews Cardiology volume 11, page 307 (2014)Cite this article

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In a very thoughtful News and Views article (Mayosi, B. M. MOGE(S): a standardized classification of cardiomyopathies? Nat. Rev. Cardiol. 11, 134–135 [2014]),1 Professor Mayosi described MOGE(S) as an “admirable achievement on the path towards a globally accepted nomenclature for cardiomyopathy”.2 He appropriately emphasized the lack of examples of aetiological notation for important cardiomyopathies from low-income and middle-income countries, such as tropical endomyocardial fibrosis (EMF; also known as tropical endomyocardial disease, constrictive endocarditis, and endocarditis parietalis fibroplastica), which is one of the most prevalent causes of restrictive cardiomyopathy.3 Mayosi suggests that an aetiological category for unexplained (or idiopathic) cardiomyopathy would improve the clinical utility of the MOGE(s) scheme.1 The authors of the scheme completely agree, and reiterate that the classification system (or nosology) is flexible, conveniently expandable, and allows easy modification of the MOGE(S) online app.4 The first update to the app has been already proposed to improve the description of arrhythmogenic right ventricular cardiomyopathy.5

EMF might provide a paradigmatic example of the flexibility of the MOGE(S) nosology and associated app. EMF is estimated to be the underlying cause of 20% of heart failure in the areas of Africa in which EMF is endemic, and is known to be the second leading cause of hospital admissions for acquired cardiovascular disease in children and young adults, after rheumatic heart disease.6 However, the aetiology of EMF remains elusive. Several hypotheses have been proposed, such as cardiotoxicity of eosinophils and hypereosinophilia (Eo), often associated with parasitic infectious aetiology (schistosomiasis, Loa loa microfilaria, filariasis, or malaria), autoimmunity (high titres of malarial antibodies, hyperimmune malarial splenomegaly, raised anti-streptolysin titres in patients with EMF), genetic or ethnic predisposition (high incidence among particular ethnic groups in some countries), diet (tuber cassava, tapioca) in association with extreme deprivation of proteins (tryptophan deficiency), and geochemical and climate characteristics (caesium derived from monazite soils).7,8,9,10,11,12,13,14 Although none of these factors has been proven to cause EMF, the MOGE(S) nosology can be invoked as follows.

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Authors and Affiliations

  1. Center for Inherited Cardiovascular Diseases, Pavia, Italy

    Eloisa Arbustini & Valentina Favalli

  2. Department of Pathology, New York Presbyterian Hospital-Weill Cornell Medical College, New York, NY, USA

    Navneet Narula

  3. Cardiology Division, Massachusetts General Hospital, Boston, MA, USA

    G. William Dec

  4. Public Health Foundation of India, New Delhi, India

    K. Srinath Reddy

  5. University of California at San Diego, San Diego, CA, USA

    Barry Greenberg

  6. Mayo Clinic College of Medicine, Rochester, MN, USA

    Sudhir Kushwaha

  7. University of Queensland, Princess Alexandra Hospital, Queensland, Australia

    Thomas Marwick

  8. Mount Sinai Medical Center, One Gustave L. Levy Place, New York, 10029, NY, USA

    Sean Pinney, Valentin Fuster & Jagat Narula

  9. Department of Industrial and Information Engineering, University of Pavia, Pavia, Italy

    Riccardo Bellazzi

  10. University of Virginia, Charlottesville, VA, USA

    Christopher Kramer

  11. John & Jennifer Ruddy Canadian Cardiovascular Research Center, University of Ottawa Heart Institute, Ottawa, ON, Canada

    Robert Roberts

  12. Methodist DeBakey Heart & Vascular Center, The Methodist Hospital, Houston, TX, USA

    William A. Zoghbi

  13. Center for Cardiovascular Innovation, Chicago, IL, USA

    Robert Bonow

  14. Maria Cecilia Hospital, GVM Care & Research, E.S., Health Science Foundation, Cotignola, Italy

    Luigi Tavazzi

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  1. Eloisa Arbustini
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  17. Jagat Narula
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Correspondence to Jagat Narula.

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Competing interests

B.G. is a consultant for Celladon, Mesoblast, Novartis, Teva Pharmaceutical, and Zensun; and is on the speakers' bureau of Boehringer Ingelheim and Otsuka. C.K. has received research support from Novartis (research funding) and Siemens Healthcare (equipment); and is a consultant for St. Jude Medical and Synarc. J.N. has received research support from GE Healthcare and Phillips (equipment to the institution from both). The other authors declare no competing interests.

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Arbustini, E., Narula, N., Dec, G. et al. MOGE(S) nosology in low-to-middle-income countries. Nat Rev Cardiol 11, 307 (2014). https://doi.org/10.1038/nrcardio.2013.219-c1

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