Cardiac Involvement in Eosinophilic Granulomatosis with Polyangiitis

This review highlights recent advances in the pathophysiology, diagnosis, and treatment of cardiac disease in patients with Eosinophilic granulomatosis with polyangiitis (EGPA). We outline a diagnostic approach to facilitate early identification of affected patients.

Recent advancements in diagnostic techniques including cardiac magnetic resonance (CMR) have improved recognition of cardiac disease in patients with EGPA. CMR has demonstrated a high prevalence of cardiac abnormalities, even in the absence of clinical symptoms, electrocardiographic or echocardiographic findings. Cardiac disease is a major cause of mortality in patients with EGPA, accounting for around 50% of disease-related deaths. However, due to the lack of standardised screening and diagnostic criteria, the true incidence remains unknown. Systemic immunosuppressive therapy is warranted to prevent acute complications as well as mitigate the long-term impact of chronic inflammation and tissue damage. Given the challenges in early detection and the prognostic significance of cardiac involvement, we recommend including CMR in the baseline evaluation of all EGPA patients at diagnosis.