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Detecting cardiac involvement with magnetic resonance in patients with active eosinophilic granulomatosis with
Sehyo Yune1, Dong-Chull Choi2, Byung-Jae Lee1
1Division of Allergy, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, South Korea.
Insights
Cardiac magnetic resonance (CMR) detects significant heart involvement in 50% of eosinophilic granulomatosis with polyangiitis (EGPA) patients, often before symptoms appear. Echocardiographic and biomarker findings can help identify EGPA patients who would benefit from CMR screening for cardiac issues.
Area of Science:
- Cardiology
- Rheumatology
- Medical Imaging
Background:
- Cardiac involvement is a critical prognostic factor in eosinophilic granulomatosis with polyangiitis (EGPA), formerly Churg-Strauss syndrome.
- Early detection of cardiac involvement in EGPA is crucial for patient management and outcomes.
Purpose of the Study:
- To characterize cardiac magnetic resonance (CMR) findings in active EGPA patients.
- To identify clinical and laboratory factors associated with cardiac involvement detected by CMR in EGPA.
Main Methods:
- Retrospective review of medical records and CMR images from 16 consecutive active EGPA patients.
- Comparison of clinical features and laboratory tests based on the presence of myocardial late gadolinium enhancement (LGE) on CMR.
- Follow-up assessment for cardiac symptoms and signs.
Main Results:
- 50% of EGPA patients (8/16) exhibited myocardial LGE on CMR, predominantly in the subendocardial layer.
- LGE extent negatively correlated with left ventricular ejection fraction (LVEF).
- LGE presence was associated with diastolic dysfunction, elevated NT-proBNP, and elevated CK-MB.
Conclusions:
- CMR effectively detects subclinical cardiac involvement in active EGPA patients.
- Echocardiographic diastolic dysfunction and elevated biomarkers (NT-proBNP, CK-MB) can identify EGPA patients who may benefit from CMR screening.
Abstract:
Cardiac involvement is the most important prognostic factor in eosinophilic granulomatosis with polyangiitis (EGPA, Churg-Strauss syndrome). The aims of this study were to describe findings of cardiac magnetic resonance (CMR) in patients with active EGPA and to find factors associated with cardiac involvement detected by CMR that could help identify patients who would benefit from the examination. Medical records and CMR images in 16 consecutive EGPA patients (8 women and 8 men, median age of 47 years ranging from 34 to 68 years) were reviewed. Clinical features and results of laboratory tests were compared according to the presence of myocardial late gadolinium enhancement (LGE) on CMR images. The patients were followed for the development of cardiac symptoms and signs (mean follow up duration, 40.5 ± 12.8 months). Among the total of 16 patients, 8 (50 %) had myocardial LGE according to CMR, located in the subendocardial layer in 7 of them (87.5 %). The extent of LGE had a significant negative correlation with left ventricular ejection fraction (LVEF, ρ = -0.723, p = 0.043). The presence of LGE was associated with larger end-systolic left ventricle internal dimension (34 vs. 28 mm, p = 0.027) and presence of diastolic dysfunction (75 vs. 0 %, p = 0.008) on echocardiography, elevated NT-proBNP (75 vs. 12.5 %, p = 0.012), and elevated CK-MB (62.5 vs. 0 %, p = 0.010) compared to the group without LGE. Only one patient (6.3 %) had cardiac symptoms before CMR and another patient (6.3 %) developed heart failure 4 years later during remission. The other 14 patients remained free from cardiac signs and symptoms during the follow-up period. In patients with active EGPA, CMR enables detection of cardiac involvement when cardiac symptoms are not present. Echocardiographic diastolic dysfunction and elevated NT-proBNP or CK-MB may help identify active EGPA patients who can benefit from CMR to detect cardiac involvement without cardiac symptoms.
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