Utility of follow-up cardiac magnetic resonance imaging in patients with eosinophilic granulomatosis with polyangiitis.

Abstract

Objectives: Cardiac involvement in eosinophilic granulomatosis with polyangiitis (EGPA) occurs in approximately 20-40% of patients and has been shown to be a major predictor of mortality. Cardiac magnetic resonance imaging (CMRI) can detect late gadolinium enhancement (LGE), which can indicate myocardial inflammation and/or fibrosis. However, the role of CMRI at diagnosis and to monitor evolution of cardiac manifestations in EGPA remains unclear. Our aim was to describe the CMRI findings in our EGPA patient cohort, including the presence and persistence of LGE, and to report on the clinical outcomes observed during follow-up.

Methods: This monocentric retrospective descriptive cohort study included 75 patients diagnosed with EGPA, who were seen at least twice between 2015 and January 2023.

Results: Among these 75 patients (male 56%, mean age at diagnosis 45 years), 30 patients underwent CMRI at diagnosis, 9 (30%) of whom had cardiac symptoms. All 30 patients (100%) were treated with glucocorticoids, with 13 (43%) also receiving cyclophosphamide. 16/30 (53%) had LGE on first CMRI; 10/11 had persistent LGE on second CMRI, 4/4 had LGE on third CMRI, and 2/2 had LGE on fourth CMRI. Of these 30 patients, 3 (10%) had cardiovascular events at follow-up, 2 of whom had atrial fibrillation (neither had LGE on their CMRIs), and 1 of whom had coronary artery disease requiring stenting (with LGE on his 4 CMRIs).

Conclusions: The role of CMRIs to study and monitor cardiac involvement in EGPA remains unclear. LGE most often persists despite treatment, with no apparent association with adverse cardiac outcomes in this cohort.