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Eosinophilic myocarditis: systematic review
Witina Techasatian1, Maan Gozun1, Kristine Vo1
1Department of Medicine, UH Mānoa JABSOM, Honolulu, Hawaii, USA.
Heart (British Cardiac Society)
|November 14, 2023
Summary
Eosinophilic myocarditis (EM) diagnosis often omits endomyocardial biopsy (EMB). Cardiac MRI (CMR) shows promise as an alternative diagnostic tool, though treatment consensus for EM remains elusive.
Area of Science:
- Cardiology
- Immunology
- Pathology
Background:
- Eosinophilic myocarditis (EM) is a rare but serious cardiac condition.
- Guidelines recommend endomyocardial biopsy (EMB) for diagnosis, but it is often forgone in clinical practice.
- Alternative diagnostic methods are needed to improve EM detection and management.
Approach:
- A systematic review of peer-reviewed articles was conducted using MEDLINE and EMBASE databases.
- Search terms included 'eosinophilic myocarditis' from inception to September 10, 2022.
- The review analyzed 239 articles, encompassing 8 observational studies and 274 patient cases.
Key Points:
- EMB confirmed diagnosis in 82.4% of cases; 17.6% were diagnosed using clinical reasoning and cardiac MRI (CMR).
- CMR-diagnosed patients presented with better cardiac function (higher ejection fraction) and less need for circulatory support.
- Idiopathic causes and eosinophilic granulomatosis with polyangiitis were the most frequent etiologies of EM.
Conclusions:
- Endomyocardial biopsy (EMB) remains the gold standard for diagnosing eosinophilic myocarditis (EM).
- Cardiac MRI (CMR) may serve as a valuable screening tool in specific clinical situations.
- Further research, including large clinical trials, is needed to establish optimal CMR utility and corticosteroid treatment regimens for EM.
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