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Clinical spectrum and endomyocardial biopsy findings in eosinophilic heart disease
Insights
Hypereosinophilic heart disease involves widespread cardiac changes beyond the endocardium. This study categorizes presentations and confirms histopathology correlates with clinical findings.
Area of Science:
- Cardiology
- Pathology
- Hematology
Background:
- Hypereosinophilia can lead to significant cardiac involvement.
- Eosinophilic heart disease (EHD) presents with diverse clinical and pathological manifestations.
Purpose of the Study:
- To analyze clinical and histopathological findings in 14 patients with hypereosinophilia and heart disease.
- To categorize EHD into distinct types and correlate findings with clinical presentation and disease course.
Main Methods:
- Conventional cardiologic methods including echocardiography, cardiac catheterization, and endomyocardial biopsy.
- Classification of cases into four types: acute carditic, ventricular dilation, restrictive, and electric disturbance.
Main Results:
- Significant myocardial changes were observed in all biopsies.
- Endomyocardial fibrosis (EMF) and myocardial degeneration were noted in various subtypes.
- Disease course varied, with acute carditic types having a shorter duration than other types (2-24 years).
Conclusions:
- Eosinophilic heart disease involves widespread cardiac pathology, not limited to the endocardium.
- Histopathological findings correlate with specific clinical presentations.
- "Eosinophilic heart disease" is a more encompassing and appropriate term for these conditions.
Abstract:
Fourteen cases of heart disease with hypereosinophilia were analyzed employing conventional cardiologic methods, including echocardiography, cardiac catheterization, and endomyocardial biopsy. The cases were divided into four types: Acute carditic (endocarditis, myocarditis, pericarditis; five cases); ventricular dilation (three cases); restrictive (three cases); electric disturbance (three cases). Biopsy revealed significant changes in all cases. In one case of the ventricular dilation type, endomyocardial fibrosis with myocardial degeneration was seen, and in another case mural thrombus formation was shown to be present. In three cases of the restrictive type, endomyocardial fibrosis (EMF) was observed. In two cases of the electric disturbance type, minor right ventricular myocardial degeneration was observed. In two of the three cases of the carditic type and in three of eight cases in other categories, postmyocarditic changes were observed. The course of the disease compared with the type of disorder revealed a short course in the carditic type and a longer course, ranging from 2 to 24 years, with one exception, in the other types. It is also confirmed that the various histopathologic changes can be related to particular clinical presentations. We have shown that the basic changes in eosinophilic heart disease are not restricted to the endomyocardium and that they occur in various parts of the heart causing more widespread manifestations. The more comprehensive term "eosinophilic heart disease" is a preferable description.