Key result
EGPA cardiac involvement spans a spectrum from reversible inflammatory myocarditis to advanced fibrotic remodeling.
Why the study?
Cardiac involvement in EGPA is a major determinant of morbidity and mortality and can occur independently of systemic disease activity.
Case Report (n=3)
Cardiac involvement in EGPA presents as a spectrum from reversible inflammation to irreversible fibrosis, requiring phenotype-based assessment and longitudinal surveillance.
Supports serial cardiac assessment in EGPA irrespective of systemic activity; extends phenotypic spectrum but leaves open prospective trials.
BACKGROUND: Cardiac involvement in eosinophilic granulomatosis with polyangiitis (EGPA) is a major determinant of morbidity and mortality and may occur independently of systemic disease activity. CASE SUMMARY: We describe 3 patients with EGPA demonstrating distinct cardiac phenotypes. Patient presentation included: 1) inflammatory cardiomyopathy with severe biventricular dysfunction that improved following escalation of immunosuppression and guideline-directed medical therapy; 2) advanced nonischemic cardiomyopathy and cardiogenic shock requiring temporary and durable mechanical circulatory support, representing an irreversible fibrotic phenotype; and 3) relapsing-remitting eosinophilic perimyocarditis and recurrent ventricular dysfunction despite multiple immunosuppressive regimens. Cardiac magnetic resonance imaging and hemodynamic assessment were central to phenotypic classification and management. DISCUSSION: EGPA cardiomyopathy exists along a spectrum from reversible inflammatory myocarditis to advanced fibrotic remodeling. Cardiac involvement may progress despite improvement in systemic manifestations and is not reliably predicted by antineutrophil cytoplasmic antibody status. TAKE-HOME MESSAGE: Phenotype-based assessment and longitudinal cardiac surveillance may guide immunosuppressive strategies and prognosis in EGPA cardiomyopathy.
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Majeed et al. (2026) conducted a case report in Eosinophilic Granulomatosis With Polyangiitis (EGPA) with cardiac involvement (n=3). Cardiac involvement in EGPA was evaluated on Cardiac phenotypes and outcomes. Cardiac involvement in eosinophilic granulomatosis with polyangiitis presents along a spectrum from reversible inflammatory myocarditis to advanced fibrotic remodeling.
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