The Critical Role of Cardiac Magnetic Resonance Imaging in Evaluating Patients With Eosinophilic Granulomatosis With Polyangiitis

Abstract

Eosinophilic granulomatosis with polyangiitis (EGPA) is a rare autoimmune systemic necrotizing vasculitis of blood vessels that often presents with hypereosinophilia. Cardiac involvement in EGPA directly correlates with the mortality of patients with the disease and is a central part of the disease process. The evaluation and treatment of cardiac anomalies are vital in patients with EGPA. The frequency with which cardiac involvement is seen in the disease process makes early diagnosis crucial in all patients with EGPA. Early treatment has been proven to reverse or cause the disease to go into remission. Several studies have shown that cardiac magnetic resonance (CMR) imaging is the most sensitive and best early indicator of cardiovascular involvement in EGPA. CMR routinely outperforms other diagnostic techniques such as ECG (echocardiography) and CTA (computed tomography angiography) in the detection of cardiac anomalies and should be a part of the standardized assessment of all patients with EGPA. CMR is also a non-invasive diagnostic tool that can also outperform biopsy in the detection of EGPA cardiac involvement. CMR is also a valuable technique that can be used to monitor disease progression while treatment is being performed. Although long-term research studies have yet to show these benefits, the studies that are available today provide ample evidence that shows CMR imaging could ultimately help bring down mortality rates currently seen in EGPA patients if it is used as an evaluation tool from initial diagnosis and throughout the entire course of disease management.

Exploring Cardiovascular Manifestations in Vasculitides: An In-Depth Review

“…Owing to its high reliability, CMR is the foremost diagnostic modality for assessing early cardiovascular complications in individuals diagnosed with EGPA [ 88 ]. Timely treatment and control of these cardiovascular complications are of immense importance, as they not only help alleviate symptoms but also facilitate achieving an early state of remission.…”

“…Timely treatment and control of these cardiovascular complications are of immense importance, as they not only help alleviate symptoms but also facilitate achieving an early state of remission. Therefore, prompt and intensive therapy involving corticosteroids and cyclophosphamide has consistently demonstrated significant enhancements in cardiac outcomes and overall prognosis in individuals diagnosed with EGPA [ 88 ].…”

Pediatric cardiothoracic vasculitis: multimodality imaging review

“…On CT, these appear as areas of ground glass or consolidation, often bilateral with a symmetrical peripheral distribution, accompanied by septal thickening in approximately half of cases [ 2 ]. Cardiac MRI has been shown to outperform other diagnostic methods in demonstrating early cardiac involvement of EGPA, arguing for its routine use [ 55 ]. Subendocardial late gadolinium enhancement is a distinct feature that is attributed to non-ischemic eosinophilic subendocardial fibrosis vs. ischemic scar from an unrecognized myocardial infarction (Fig.…”

“…9 ) [ 56 ]. Other findings might include wall motion abnormalities, increased native T1, increased myocardial extracellular volume, increased extracellular matrix mass, and non-ischemic late gadolinium enhancement (e.g., mesocardial, epicardial, right ventricular insertion site or a combination) [ 55 , 56 ].

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