Cardiac Involvement in Eosinophilic Granulomatosis with Polyangiitis: A Meta-analysis of 62 Case Reports

Abstract

Background: Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare multi-systemic vasculitis, with cardiac involvement being one of its most serious manifestations. We aimed to systematically review and analyze the limited case reports of EGPA with cardiac involvement.
 f EGPA with cardiac involvement. Methods: Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we performed a systematic literature search for the case reports of EGPA with cardiac involvement in the MEDLINE database from 2011 until 2018. For each case, clinical data including sex, age, clinical presentation, electrocardiographic and cardiac imaging findings, the type of cardiac involvement, the available laboratory data (cardiac biomarkers, white blood cell count, eosinophilic count, erythrocyte sedimentation rate, C-reactive protein, and antineutrophil cytoplasmic antibody positivity), therapeutic regimen, and the outcome of the patients were collected and analyzed.
 Results: A total number of 62 cases were included. The mean age was 48.29±15.60 years, and 51.6% were male. All the cases were in the active disease state. Cardiac symptoms, electrocardiographic abnormalities, abnormal biomarkers, and abnormal echocardiography were detected in 82.3%, 68.5%, 77.4%, and 96.8%, respectively. Cardiac magnetic resonance was done in 46.8% of the patients, and it was abnormal in all. The most common abnormal findings in echocardiography were systolic left ventricular dysfunction (83.9%) and pericardial effusion (37.1%). The most common type of clinical presentation was clinical heart failure (51.6%). Only 6.5% of the patients presented with tamponade. The overall prognosis was good.
 Conclusion: Any part of the heart could be involved by EGPA. The results emphasize the necessity of in-depth cardiac evaluation in these patients.

Cardiac Involvement in Eosinophilic Granulomatosis With Polyangiitis: A Retrospective Study in the Chinese Population

“…A diagnosis of cardiac involvement was made using a combination of clinical manifestations; myocardial enzyme levels; and ECG, coronary artery CTA, echocardiography, and cardiac MRI findings. Chest pain was a common symptom in patients with cardiac involvement, which is in accordance with some previous studies (15,33). However, almost half of the patients were asymptomatic or had normal ECGs, and cardiac abnormalities were only detected by echocardiography or cardiac MRI.…”

Case Report: Area of Focus of Myocardial Infarction With Non-obstructive Coronary Arteries in Eosinophilic Granulomatosis With Polyangiitis

“…According to a meta-analysis of 62 patients diagnosed with EGPA with cardiac involvement ( 18 ), EGPA may mimic acute coronary syndrome with nonspecific ST-T changes or, rarely, ST elevation on ECG, the etiologies of which may be coronary vasospasm, intracoronary thrombi, coronary artery stenotic lesions or coronary ectasia. In our case, no evidence of coronary vasospasm was revealed on CAG, and, considering the patient was in the acute phase of STEMI, we did not conduct a provocation test for coronary spasm.…”

A case report of myocardial infarction with non-obstructive coronary arteries as the initial presentation of eosinophilic granulomatosis with polyangiitis

“…Cardiac manifestations during the presentation of EGPA have been associated with high mortality and increased rates of relapse. 10 , 11 A recent meta-analysis by Pakbaz and Pakbaz 12 reviewed 62 cases of EGPA between 2011 and 2018 and concluded cardiac symptoms, electrocardiographic abnormalities, abnormal biomarkers, and abnormal echocardiography in 82.3%, 68.5%, 77.4%, and 96.8% of the patient population, respectively. While clinical evidence of myocardial involvement can be uncommon in the setting of EGPA, 13 utilization of CMR has become the gold standard to properly diagnose the disease and guide appropriate therapy for individuals with underlying myocardial injury in the setting of MINOCA.…”

“… 14 CMR performed in 46.8% of the patients was abnormal in all cases and findings were significant for coronary arteritis (12.9%) and endomyocardial fibrosis (30.6%). 12 Of note, angiogram was also performed in those presenting with chest pain and showed normal coronary arteries or mild coronary lesions in 63.6%. 12 Furthermore, in a systemic review by Pasupathy et al .…”

“… 12 Of note, angiogram was also performed in those presenting with chest pain and showed normal coronary arteries or mild coronary lesions in 63.6%. 12 Furthermore, in a systemic review by Pasupathy et al . 15 of approximately 1500 patients, CMR provided an identifiable basis of troponin elevation in nearly 74% of the patients and an astounding 79% when imaging was performed within 6 weeks of presentation.…”