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Cardiovascular features of 11 patients with eosinophilic endomyocardial disease
Insights
Eosinophilic endomyocardial disease, a heart condition, can be effectively diagnosed and treated at all stages. This study highlights advancements in investigating and managing this hypereosinophilic syndrome.
Area of Science:
- Cardiology
- Pathology
- Internal Medicine
Background:
- Eosinophilic endomyocardial disease (EEMD) involves heart inflammation and damage due to hypereosinophilia.
- Patients may present with pre-existing heart disease or develop it after hypereosinophilia onset.
Purpose of the Study:
- To describe clinical features, cardiac investigations, and treatment outcomes in patients with EEMD.
- To evaluate diagnostic methods for different stages of EEMD.
- To assess treatment efficacy for heart failure and valvular disease in EEMD.
Main Methods:
- Longitudinal follow-up of eleven patients with biventricular EEMD.
- Histological examination of endomyocardial biopsies to identify lesion types (necrotic, thrombotic, fibrotic).
- Cardiac imaging including 2D echocardiography and angiocardiography for lesion characterization.
Main Results:
- Three patients died during the mean 3.2-year follow-up.
- Endomyocardial biopsy was crucial for diagnosing early necrotic and thrombotic lesions.
- Late fibrotic lesions were identified using echocardiography and angiocardiography.
- Prednisolone effectively managed heart failure and potentially inhibited disease progression.
- Surgical treatment improved outcomes for patients with severe ventricular disease and valvular regurgitation.
Conclusions:
- EEMD can be effectively investigated and treated across all disease stages.
- Diagnostic strategies should be tailored to the stage of EEMD.
- Multimodal treatment approaches, including medication and surgery, are vital for managing EEMD.
Abstract:
This report describes the clinical features, cardiac investigations and treatment of eleven patients with biventricular eosinophilic endomyocardial disease, who were followed up for a mean of 3.2 years. Three patients died. Five patients presented with heart disease and hypereosinophilia. Six other patients presented with hypereosinophilia and developed cardiac disease later. Histological studies showed early acute necrotic lesions in five patients, later thrombotic lesions in one and late fibrotic lesions in three patients. Endomyocardial biopsy was the method of choice for diagnosing early acute necrotic and thrombotic lesions. Late fibrotic lesions were best shown by amplitude processed 2D echocardiography and angiocardiography. Episodes of heart failure responded well to treatment with prednisolone which appeared to inhibit progression of heart disease in two patients. Three patients with severe ventricular disease and valvular regurgitation responded well to surgical treatment. This longitudinal study has shown that eosinophilic endomyocardial disease can now be investigated and treated effectively at each stage from early sub-clinical lesions to late incapacitating endomyocardial fibrosis.