Key result
Eosinophilic myocarditis in hypereosinophilic syndrome is linked to a ~2.6-fold higher rate of thromboembolic events.
Why the study?
Data are limited regarding eosinophilic myocarditis in hypereosinophilic syndrome, prompting a review of contemporary clinical characteristics, demographics, cardiac imaging, and outcomes.
Cross-Sectional (n=36)
No
Absolute Event Rate: 63.6% vs 24%
p-value: p=0.02
Patients with hypereosinophilic syndrome and eosinophilic myocarditis have a high incidence of thromboembolic events, underscoring the importance of cardiac magnetic resonance for accurate screening and detection.
May warrant closer thromboembolic surveillance in hypereosinophilic syndrome with myocarditis; hypothesis-generating and requires prospective validation.
Background: Hypereosinophilic syndrome (HES) represents a group of disorders with eosinophil-mediated end-organ damage. Eosinophilic myocarditis (EM) represents cardiac involvement in HES. Data are limited regarding this rare condition. To better understand contemporary clinical characteristics of EM in HES, we reviewed demographics, cardiac imaging, and outcomes of this condition at our center. Methods: We performed a cross-sectional study of all patients aged >18 years with diagnosis of EM in HES at our center between September 1986 and January 2023. Relevant clinical data, including clinical presentation, medical history, medication use, comorbidities, imaging findings, and outcomes, were collected and analyzed. Results: Of 1,664 patients identified with hypereosinophilia (HE), 36 cases of clinically diagnosed HES were identified. Of the 36 patients diagnosed with HES, 11 patients (30.6%) were diagnosed with EM. Of these, six patients underwent endomyocardial biopsy (EMB). The mean age was 57±12 years and 63.6% were female. Asthma was the most common comorbidity (54.5%). Patients with EM had significantly more dyspnea (63.6%), fatigue (54.5%), and neuropathy (36.4%) compared to those without cardiac involvement. Echocardiography was performed in all patients and cardiac magnetic resonance (CMR) imaging was performed in eight patients. Left ventricular (LV) thrombus was detected more frequently by CMR (5/8, 62.5%) compared to echocardiography (3/10, 30%). Subendocardial pattern of late gadolinium enhancement (LGE) was observed in the majority of patients on CMR (6/7, 85.7%). Steroids were utilized in 90.9% of cases, and aspirin in all patients. Compared to HES patients without cardiac involvement, thromboembolic events occurred significantly more frequently (63.6% vs. 24.0%, P=0.02). Conclusions: In a 37-year cohort of HES-associated EM, echocardiography was the first-line imaging modality, while CMR was an essential but still under-utilized imaging modality. Patients with EM had significantly more thromboembolic events compared to HES without cardiac involvement.
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Reeder et al. (2024) conducted a cross-sectional in Hypereosinophilic syndrome and eosinophilic myocarditis (n=36). Eosinophilic myocarditis vs. Hypereosinophilic syndrome without cardiac involvement was evaluated on Thromboembolic events (p=0.02). Patients with eosinophilic myocarditis in the setting of hypereosinophilic syndrome experienced significantly more thromboembolic events compared to those without cardiac involvement (63.6% vs. 24.0%, P=0.02).
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