1. Michela Brambatti et al. JACC 2017;70:2363-2375
Findings at Presentation of an Exemplificative Case of Fulminant Eosinophilic Myocarditis Associated With Eosinophilic Granulomatosis With Polyangiitis (A) Electrocardiogram showed sinus tachycardia (153 beats/min), low voltage of R waves on V1 to V4, and ST-segment depression in V4 to V6. (B) Chest x-ray after venous arterial extracorporeal membrane oxygenator and intra-aortic balloon pump placement due to cardiogenic shock and pulmonary edema. Online Videos 1 and 2 show echocardiograms of severe left ventricular systolic function with mild chamber dilation from the same patient. (C,D) Endomyocardial biopsies at admission and before discharge, (C) hematoxylin and eosin staining: diffuse interstitial eosinophil infiltrates (black arrows) with areas of necrosis (white arrows). Eosinophils infiltrate the interstitial compartment and cause necrosis by degranulation of cytotoxic cationic proteins. (D) A second endomyocardial biopsy showed myocyte replacement with extensive fibrosis (black arrows) without eosinophil infiltrate. At the time of the second endomyocardial biopsy there was no eosinophilia and high-sensitivity troponin T was within normal values. (E,F) Cardiac magnetic resonance at discharge showed diffuse areas of late gadolinium enhancement with both transmural involvement at the distal septum level (E, arrow) (in 4-chamber view) and endomyocardial involvement of the inferior septum, inferior and inferolateral wall (F, arrows) (in short-axis view). The latter pattern is more typical of myocardial involvement in eosinophilic myocarditis. (G,I) Native T1 mapping (modified Look-Locker inversion recovery sequences) to assess residual area of edema at cardiac magnetic resonance at discharge and at 1-year follow-up. A significant decrease of T1 mapping signal was detected (from 1,145 to 991 ms; values refer to the area within the black circle) in the anterior myocardium. Normal myocardial values are around 960 ms for this sequence.
Michela Brambatti et al. JACC 2017;70:
2017 American College of Cardiology Foundation