Impact of cardiac magnetic resonance imaging on eosinophilic granulomatosis with polyangiitis outcomes: A long-term retrospective study on 42 patients.

Abstract

OBJECTIVE:

To determine the diagnostic and prognostic significance of cardiac magnetic resonance imaging (CMRI) in a cohort of patients with eosinophilic granulomatosis with polyangiitis (EGPA).

METHODS:

We conducted a monocentric retrospective study including 42 EGPA patients who had consecutively undergone CMRI at diagnosis or during follow-up, independently of signs of cardiac involvement.

RESULTS:

Forty-two patients (male 59.5%, mean age at diagnosis 46.5 years) were included. ANCA was positive in 26.2%, and median EGPA duration before the 1st CMRI screening was 5 months. Seventeen (40.5%) were diagnosed with cardiomyopathy, independently of CMRI findings. CMRI showed myocardial late gadolinium enhancement (LGE) in 82.4% patients with cardiomyopathy vs. 44% without cardiomyopathy (P=0.024). Using LGE as the sole criterion, CMRI sensitivity and specificity for diagnosing cardiomyopathy were 82.4% and 56%, respectively. Among the 15 patients with cardiomyopathy who underwent additional CMRI during follow-up, CMRI-detected cardiac lesions had improved in 7 patients, while those of 8 patients worsened or stabilized despite treatment. These latter patients presented with significantly more cardiac events during follow-up (P=0.026). No differences were found between non-cardiomyopathic patients with or without CMRI anomalies concerning EGPA cardiac manifestations and outcomes.

CONCLUSION:

The diagnostic significance of myocardial LGE in EGPA patients remains uncertain and should not be the only criterion for cardiomyopathy diagnosis. For patients with no other signs of cardiomyopathy, CMRI-detected anomalies do not seem to adversely affect prognosis or outcome. For patients with cardiomyopathy, CMRI reassessment seems promising in detecting patients with a less favorable cardiac outcome.

• Authors: Bertrand Dunogué, Benjamin Terrier, Pascal Cohen, Julien Marmursztejn, Paul Legmann, Luc Mouthon, Denis Duboc, Olivier Vignaux, Loïc Guillevin, French Vasculitis Study Group
• Journal: Autoimmunity reviews (Autoimmun Rev) Vol. 14 Issue 9 Pg. 774-80 (Sep 2015) ISSN: 1873-0183 [Electronic] Netherlands
• PMID: 25960167 (Publication Type: Journal Article, Review)
• Copyright: Copyright © 2015 Elsevier B.V. All rights reserved.

Topics

• Eosinophils
• Granulomatosis with Polyangiitis (pathology)
• Humans
• Magnetic Resonance Imaging (methods)
• Myocardium (pathology)
• Prognosis
• Retrospective Studies