Butterfield Joseph H, Kane Garvan C, Weiler Catherine R
a Division of Allergic Diseases, and Mayo Clinic Program for Mast Cell and Eosinophilic Disorders , Mayo Clinic , Rochester , MN , USA.
b Department of Cardiovascular Diseases , Mayo Clinic , Rochester , MN , USA.
Postgrad Med. 2017 Jun;129(5):517-523. doi: 10.1080/00325481.2017.1317215. Epub 2017 Apr 25.
To compare echocardiograms and endomyocardial biopsies to diagnose cardiac involvement in hypereosinophilic syndrome.
We examined the agreement between echocardiography and endomyocardial biopsies to detect cardiac involvement in hypereosinophilic syndrome by reviewing cases identified as hypereosinophilia or hypereosinophilic syndrome in Mayo Clinic databases from January 1978 through June 2009. Single-organ cases of eosinophilia such as eosinophilic fasciitis and eosinophilic gastroenteritis were excluded. We recorded echocardiogram and endomyocardial biopsy results including biopsy staining for eosinophil granule major basic protein (if performed). Clinical and laboratory features documented included presenting symptom(s), maximum total eosinophil count, dose of prednisone (if any) and eosinophil count at the time of endomyocardial biopsy, cardiac enzymes, serum tryptase level, electrocardiogram result, the result of testing for the FIP1L1-PDGFRA fusion gene, complications associated with the biopsy procedures and available follow-up information.
From a total of 387 patients' records screened 288 met the criteria for hypereosinophilic syndrome and of these 240 had echocardiograms. Among these patients there were 138 normal echocardiograms, 67 had echocardiograms without findings of hypereosinophilic syndrome but with one or more other abnormalities, and 35 had echocardiograms with findings consistent with hypereosinophilic syndrome. Twenty-five patients from this group of 35 patients had both echocardiogram and endomyocardial biopsy. In 15 patients there was agreement between both endomyocardial biopsy and echocardiography as to the presence (n = seven) or absence (n = eight) for findings of cardiac involvement. In 10 of 25 patients test results diverged: 3 patients with positive echocardiographic changes did not have confirmatory findings by endomyocardial biopsy and seven patients with positive biopsy findings had echocardiograms without findings of hypereosinophilic syndrome.
Echocardiograms and endomyocardial biopsies agree for presence or absence of cardiac involvement 60% of the time. Endomyocardial biopsy detected cardiac involvement in 7 patients in whom the echocardiogram was negative for findings of hypereosinophilic syndrome.
比较超声心动图和心内膜心肌活检在诊断高嗜酸性粒细胞综合征心脏受累情况中的作用。
通过回顾1978年1月至2009年6月梅奥诊所数据库中确诊为嗜酸性粒细胞增多症或高嗜酸性粒细胞综合征的病例，我们研究了超声心动图和心内膜心肌活检在检测高嗜酸性粒细胞综合征心脏受累方面的一致性。排除了嗜酸性粒细胞增多症的单器官病例，如嗜酸性筋膜炎和嗜酸性胃肠炎。我们记录了超声心动图和心内膜心肌活检结果，包括活检中嗜酸性粒细胞颗粒主要碱性蛋白的染色情况（如果进行了此项检查）。记录的临床和实验室特征包括出现的症状、最高嗜酸性粒细胞总数、泼尼松剂量（如果使用过）以及心内膜心肌活检时的嗜酸性粒细胞计数、心肌酶、血清类胰蛋白酶水平、心电图结果、FIP1L1-PDGFRA融合基因检测结果、活检相关并发症以及可用的随访信息。
在总共筛查的387例患者记录中，288例符合高嗜酸性粒细胞综合征标准，其中240例进行了超声心动图检查。在这些患者中，138例超声心动图正常，67例超声心动图未发现高嗜酸性粒细胞综合征表现但有一项或多项其他异常，35例超声心动图表现与高嗜酸性粒细胞综合征一致。这35例患者中有25例同时进行了超声心动图和心内膜心肌活检。在15例患者中，心内膜心肌活检和超声心动图在心脏受累表现的存在（n = 7）或不存在（n = 8）方面意见一致。在25例患者中的10例中，检测结果不一致：3例超声心动图有阳性改变的患者心内膜心肌活检未得到证实，7例活检有阳性发现的患者超声心动图未发现高嗜酸性粒细胞综合征表现。
超声心动图和心内膜心肌活检在心脏受累情况的存在与否上有60%的一致性。心内膜心肌活检检测到7例超声心动图未发现高嗜酸性粒细胞综合征表现但存在心脏受累的患者。
