Clinical spectrum and endomyocardial biopsy findings in eosinophilic heart disease

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.

Loeffler’s Endocarditis and Hypereosinophilic Syndrome

“…Cationic protein has also been noted to play a role by binding to endothelial thrombomodulin, resulting in a hypercoagulable state. 7,14,[18][19][20][21][22][23] Damage to the vascular wall by eosinophils also exposes the subendothelial collagen and von Willebrand factor that leads to a hypercoagulable state. 14,24,25…”

Allergy and the Heart

“…Eosinophilic myocarditis is a major cause of morbidity and mortality among patients with HES and should be considered even in patients who lack peripheral eosinophilia ( 4 , 5 , 6 , 7 ). Eosinophil-mediated heart damage evolves through 3 stages: an acute necrotic stage, an intermediate stage characterized by thrombus formation along the damaged endocardium, and a fibrotic stage characterized by altered cardiac function due to restrictive cardiomyopathy and/or entrapment of the chordae tendineae leading to mitral and tricuspid regurgitation ( 7 ).…”

Eosinophilic Myocarditis Presenting as ST-segment Elevation Myocardial Infarction Diagnosed with Cardiac Magnetic Resonance Imaging

“…3 The current understanding of eosinophilic myocarditis describes a 3-stage process of myocardial injury. 4,5,[8][9][10] The first stage is the acute necrotic phase, which involves myocardial infiltration with eosinophils and toxic degranulation, resulting in myocardial injury. This stage is typically subclinical and patients are often asymptomatic.…”