Division of Cardiology, Department of Medicine, University of California San Diego, San Diego, California.
Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital, "Ospedali Riuniti," Ancona, Italy.
J Am Coll Cardiol. 2017 Nov 7;70(19):2363-2375. doi: 10.1016/j.jacc.2017.09.023.
Eosinophilic myocarditis (EM) is an acute life-threatening inflammatory disease of the heart. Neither large case series nor clinical trials on this specific myocarditis have been reported.
Based on a systematic revision of all published histologically proven cases, this study aimed to describe the clinical presentation, treatment, and outcome of EM.
The study screened 443 manuscripts in MEDLINE and EMBASE on cases of EM published until June 2017. The authors identified 264 patients and included in the main analysis 179 patients admitted to hospital with histologically proven EM.
Median age was 41 years (interquartile range: 27 to 53 years) with similar prevalence in both sexes; pediatric cases (≤16 years of age) accounted for 10.1%. The main symptom at presentation was dyspnea (59.4%), with peripheral eosinophilia observed in 75.9%. Median left ventricular ejection fraction at presentation was 35% (interquartile range: 25% to 50%). The disorders most frequently associated with EM were hypersensitivity and eosinophilic granulomatosis with polyangiitis, which accounted for 34.1% and 12.8% of cases, respectively, whereas idiopathic or undefined forms accounted for 35.7% of cases. Steroids were administered in 77.7% of patients. A temporary mechanical circulatory support (n = 30) was instituted in 16.8% of patients. In-hospital death was 22.3% (n = 40), with the highest occurrence in the hypersensitivity form (36.1%; p = 0.026).
EM has a poor prognosis during the acute phase, despite a publication bias that could have led to an overestimation of mortality. Associated conditions are identified in approximately 65% of cases. Specific trials and multicenter registries are needed to provide evidence-based treatments to improve in-hospital outcome.
嗜酸性心肌炎（EM）是一种危及生命的急性心脏炎症性疾病。目前尚未报道关于这种特定心肌炎的大型病例系列或临床试验。
本研究通过对所有已发表的经组织学证实的病例进行系统回顾，旨在描述 EM 的临床表现、治疗和转归。
本研究在 MEDLINE 和 EMBASE 中筛选了截至 2017 年 6 月发表的关于 EM 的 443 篇文献。作者共识别出 264 例患者，其中 179 例因经组织学证实的 EM 住院，纳入主要分析。
中位年龄为 41 岁（四分位间距：27 至 53 岁），男女患病率相似；儿科病例（≤16 岁）占 10.1%。就诊时的主要症状是呼吸困难（59.4%），75.9%的患者外周血嗜酸性粒细胞增多。就诊时左心室射血分数中位数为 35%（四分位间距：25%至 50%）。与 EM 相关的疾病最常见的是过敏和嗜酸性肉芽肿伴多血管炎，分别占 34.1%和 12.8%，而特发性或未明形式占 35.7%。77.7%的患者接受了类固醇治疗。16.8%的患者（n=30）接受了临时机械循环支持。住院死亡率为 22.3%（n=40），过敏型发生率最高（36.1%；p=0.026）。
尽管存在发表偏倚可能导致死亡率高估，但在急性阶段 EM 的预后仍较差。大约 65%的病例可识别出相关疾病。需要进行专门的临床试验和多中心登记研究，以提供循证治疗方法，改善住院结局。
