Heart disease in eosinophilic granulomatosis with polyangiitis (EGPA) patients: a screening approach proposal

Abstract Objective To define the pattern of cardiac involvement in eosinophilic granulomatosis and polyangiitis (EGPA) and propose an algorithm for heart disease screening. Methods This was a retrospective study of EGPA patients attending a specialized vasculitis clinic (1989–2016). Clinical charact...

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Published in:Rheumatology (Oxford, England) England), 2021-10, Vol.60 (10), p.4538-4547
Main Authors: Garcia-Vives, Eloi, Rodriguez-Palomares, J F, Harty, Len, Solans-Laque, Roser, Jayne, David
Format: Article
Language:English
Subjects:
Adult
Algorithms
Early Diagnosis
Echocardiography
Electrocardiography
Eosinophilia - blood
Eosinophilia - complications
Eosinophilia - diagnostic imaging
Eosinophils
Female
Granulomatosis with Polyangiitis - blood
Granulomatosis with Polyangiitis - complications
Granulomatosis with Polyangiitis - diagnostic imaging
Heart Disease Risk Factors
Heart Diseases - diagnosis
Heart Diseases - etiology
Humans
Magnetic Resonance Angiography
Male
Mass Screening - methods
Middle Aged
Retrospective Studies
Risk Assessment
Troponin - blood
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Summary:Abstract Objective To define the pattern of cardiac involvement in eosinophilic granulomatosis and polyangiitis (EGPA) and propose an algorithm for heart disease screening. Methods This was a retrospective study of EGPA patients attending a specialized vasculitis clinic (1989–2016). Clinical characteristics and cardiovascular evaluation (CE) results (serum troponin, ECG, echocardiography and cardiac magnetic resonance) were collected and compared according to symptoms and inflammatory cardiac disease (ICD). Results A total of 131 EGPA patients were included, of whom 96 (73%) had undergone CE. The median (interquartile range) age was 50 (38–58) years and 36% showed ANCA+. Asthma preceded diagnosis by a median of 97 (36–240) months. Among the 96 patients who underwent CE, 43% were symptomatic, with dyspnea (47%) and chest pain (29%) being the predominant symptoms. In asymptomatic patients, CE reported abnormalities in 45% of cases, with a subsequent earlier diagnosis (4 vs 11 months). Overall, 27 patients had EGPA-related ICD (EGPA-rICD) that was already present at diagnosis in 20 cases, preceded it in 2 cases and developed later in 5 cases. EGPA-rICD patients were younger (46 vs 50 years; P = 0.04), had more frequently abnormal ECG (30.8 vs 2.1%; P 
ISSN:1462-0324
1462-0332
DOI:10.1093/rheumatology/keab027