Eosinophilic cardiomyopathy: Difference between revisions

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  | doi = 10.1016/j.amjms.2017.04.002
  | doi = 10.1016/j.amjms.2017.04.002
  | pmid = 29173361
  | pmid = 29173361
}}</ref> It is a feature of [[Hypereosinophilic Syndrome]] and occurs in 40-50% of all cases.  Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines. This process leads to tissue damage and dysfunction, eventually leading to fibrosis and [[restrictive cardiomyopathy]]. There are 3 stages of the Eosinophilic cardiomyopathy: Stage 1 that is acute necrotic stage, stage 2 that is mural [[thrombi]]/ [[thrombus]] formation, and stage 3 that is ibrotic stage. There are many causes of [[Hypereosinophilic Syndrome]] (HES) with Eosinophilic Cardiomyopathy, these can be classified as reactive, conal myeloid disorder, and idiopathic hypereosinophillic syndrome.
}}</ref> It is a feature of [[hypereosinophilic syndrome]] and occurs in 40-50% of all cases.  Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines. This process leads to tissue damage and dysfunction, eventually leading to fibrosis and [[restrictive cardiomyopathy]]. There are 3 stages of the eosinophilic cardiomyopathy: Stage 1 that is acute necrotic stage, stage 2 that is mural [[thrombi]]/ [[thrombus]] formation, and stage 3 that is ibrotic stage. There are many causes of [[hypereosinophilic syndrome]] (HES) with eosinophilic cardiomyopathy, these can be classified as reactive, conal myeloid disorder, and idiopathic hypereosinophillic syndrome.
==Historical Perspective==
==Historical Perspective==
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
*Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].<ref>{{Cite journal
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==Pathophysiology==
==Pathophysiology==
*The pathogenesis of Eosinophilic Cadiomyopathy is characterized by [[hypereosinophilia]] <ref>{{Cite journal
*The pathogenesis of eosinophilic cadiomyopathy is characterized by [[hypereosinophilia]] <ref>{{Cite journal
  | author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
  | author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
  | title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
  | title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
Line 347: Line 347:


==Differentiating [disease name] from other Diseases==
==Differentiating [disease name] from other Diseases==
* Eosinophilic Cardiomyopathy must be differentiated from other diseases that cause [[Cardiac hypertrophy]], cardiac fibrosis, and [[Heart failure]]<ref>{{Cite journal
* Eosinophilic cardiomyopathy must be differentiated from other diseases that cause [[cardiac hypertrophy]], cardiac fibrosis, and [[heart failure]]<ref>{{Cite journal
  | author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
  | author = [[Petar M. Seferovic]], [[Marija Polovina]], [[Johann Bauersachs]], [[Michael Arad]], [[Tuvia Ben Gal]], [[Lars H. Lund]], [[Stephan B. Felix]], [[Eloisa Arbustini]], [[Alida L. P. Caforio]], [[Dimitrios Farmakis]], [[Gerasimos S. Filippatos]], [[Elias Gialafos]], [[Vladimir Kanjuh]], [[Gordana Krljanac]], [[Giuseppe Limongelli]], [[Ales Linhart]], [[Alexander R. Lyon]], [[Ruzica Maksimovic]], [[Davor Milicic]], [[Ivan Milinkovic]], [[Michel Noutsias]], [[Ali Oto]], [[Oztekin Oto]], [[Sinisa U. Pavlovic]], [[Massimo F. Piepoli]], [[Arsen D. Ristic]], [[Giuseppe M. C. Rosano]], [[Hubert Seggewiss]], [[Milika Asanin]], [[Jelena P. Seferovic]], [[Frank Ruschitzka]], [[Jelena Celutkiene]], [[Tiny Jaarsma]], [[Christian Mueller]], [[Brenda Moura]], [[Loreena Hill]], [[Maurizio Volterrani]], [[Yuri Lopatin]], [[Marco Metra]], [[Johannes Backs]], [[Wilfried Mullens]], [[Ovidiu Chioncel]], [[Rudolf de Boer]], [[Stefan Anker]], [[Claudio Rapezzi]], [[Andrew J. S. Coats]] & [[Carsten Tschope]]
  | title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
  | title = Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology
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==Epidemiology and Demographics==
==Epidemiology and Demographics==
* The prevalence of [[Hypereosinophilic Syndrome]] is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
* The prevalence of [[hypereosinophilic syndrome]] is approximately 0.036 per 100,000 individuals worldwide. <ref>{{Cite journal
  | author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
  | author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
  | title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
  | title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
Line 403: Line 403:


===Age===
===Age===
*Patients of all age groups may develop Eosinophilic Cardiomyopathy.<ref>{{Cite journal
*Patients of all age groups may develop ecosinophilic cardiomyopathy.<ref>{{Cite journal
  | author = [[Jason Gotlib]]
  | author = [[Jason Gotlib]]
  | title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
  | title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
Line 442: Line 442:
  | pmid = 17868859
  | pmid = 17868859
}}</ref>
}}</ref>
* The Male to Female ratio is approximately 1.47. <ref>{{Cite journal
* The male to female ratio is approximately 1.47. <ref>{{Cite journal
  | author = [[Jason Gotlib]]
  | author = [[Jason Gotlib]]
  | title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
  | title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
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===Race===
===Race===
*There is no racial predilection for Eosinophilic Cardiomyopathy.
*There is no racial predilection for eosinophilic cardiomyopathy.


==Risk Factors==
==Risk Factors==
*Common risk factors in the development of Eosinophilic Cardiomyopathy are [[HLA]] Bw44 positivity, [[splenomegaly]], [[thrombocytopenia]], elevated [[vitamin B12]] levels, dysplastic [[eosinophils]], and abnormal early myeloid precursors.<ref>{{Cite journal
*Common risk factors in the development of eosinophilic cardiomyopathy are [[HLA]] Bw44 positivity, [[splenomegaly]], [[thrombocytopenia]], elevated [[vitamin B12]] levels, dysplastic [[eosinophils]], and abnormal early myeloid precursors.<ref>{{Cite journal
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
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== Natural History, Complications and Prognosis==
== Natural History, Complications and Prognosis==
*Some patients with Eosinophilic Cardiomyopathy may present asymptomatic.<ref>{{Cite journal
*Some patients with eosinophilic cardiomyopathy may present asymptomatic.<ref>{{Cite journal
  | author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
  | author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
  | title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
  | title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
Line 525: Line 525:
== Diagnosis ==
== Diagnosis ==
===Diagnostic Criteria===
===Diagnostic Criteria===
*The diagnosis of [[Hypereosinophilic syndrome]] is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
*The diagnosis of [[hypereosinophilic syndrome]] is made when at least one of the following three diagnostic criteria are met:<ref>{{Cite journal
  | author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
  | author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
  | title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
  | title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
Line 553: Line 553:


=== Symptoms ===
=== Symptoms ===
* Eosinophilic Cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
* Eosinophilic cardiomyopathy is may present asymptomatic early in the course.<ref>{{Cite journal
  | author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
  | author = [[Ming Gao]], [[Weihua Zhang]], [[Waiou Zhao]], [[Ling Qin]], [[Fei Pei]] & [[Yang Zheng]]
  | title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
  | title = Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature
Line 565: Line 565:
  | pmid = 29538200
  | pmid = 29538200
}}</ref>
}}</ref>
*Symptoms of Eosinophilc Cardiomypoathy may include the following:<ref>{{Cite journal
*Symptoms of eosinophilc cardiomypoathy may include the following:<ref>{{Cite journal
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
Line 585: Line 585:
  | pmid = 30989768
  | pmid = 30989768
}}</ref>
}}</ref>
:*[[Fever]]
** [[Fever]]
:*[[Dyspnea]] at rest or on exertion
** [[Dyspnea]] at rest or on exertion
:*[[Chest pain]]
** [[Chest pain]]
:*[[Cough]]
** [[Cough]]
:*[[Rash]]
** [[Rash]]
:*[[Malaise]]
** [[Malaise]]


=== Physical Examination ===
=== Physical Examination ===
*Patients with Eosinophilic Cardiomyopathy usually appear distressed.
*Patients with eosinophilic cardiomyopathy usually appear distressed.
*Physical examination may be remarkable for:<ref>{{Cite journal
*Physical examination may be remarkable for:<ref>{{Cite journal
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
Line 614: Line 614:
  | pmid = 30989768
  | pmid = 30989768
}}</ref>
}}</ref>
:*[[Fever]]
** [[Fever]]
:*[[Tachycardia]]
** [[Tachycardia]]
:*[[Tachypnea]]
** [[Tachypnea]]
:*[[Arrythmia]]
** [[Arrythmia]]
:*[[Rash]]
** [[Rash]]
:*[[Embolic]] events
** [[Embolic]] events


=== Laboratory Findings ===
=== Laboratory Findings ===
Line 635: Line 635:
  | pmid = 17868859
  | pmid = 17868859
}}</ref>
}}</ref>
*An elevated concentration of [[eosinophils]] in [[peripheral blood smear]] is diagnostic of [[Hypereosinophilic syndrome]].<ref>{{Cite journal
*An elevated concentration of [[eosinophils]] in [[peripheral blood smear]] is diagnostic of [[hypereosinophilic syndrome]].<ref>{{Cite journal
  | author = [[Jason Gotlib]]
  | author = [[Jason Gotlib]]
  | title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
  | title = World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management
Line 647: Line 647:
  | pmid = 26486351
  | pmid = 26486351
}}</ref>
}}</ref>
*Other laboratory findings consistent with the diagnosis of  Eosinophilic cardiomyopathy include abnormal [[bone marrow biopsy]], and abnormal [[troponins]].<ref>{{Cite journal
*Other laboratory findings consistent with the diagnosis of  eosinophilic cardiomyopathy include abnormal [[bone marrow biopsy]], and abnormal [[troponins]].<ref>{{Cite journal
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
Line 662: Line 662:
===Imaging Findings===
===Imaging Findings===
   
   
*Cardiac [[MRI]] is the imaging modality of choice for Eosinophilic cardiomyopathy.<ref>{{Cite journal
*Cardiac [[MRI]] is the imaging diagnostic study of choice for eosinophilic cardiomyopathy.<ref>{{Cite journal
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
Line 674: Line 674:
  | pmid = 17868859
  | pmid = 17868859
}}</ref>
}}</ref>
*On Cardiac [[MRI]], Eosinophilic Cardiomyopathy is characterized by hyper-enhancement and thrombus formation. <ref>{{Cite journal
*On cardiac [[MRI]], eosinophilic cardiomyopathy is characterized by hyper-enhancement and thrombus formation. <ref>{{Cite journal
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
Line 686: Line 686:
  | pmid = 17868859
  | pmid = 17868859
}}</ref>
}}</ref>
*[[Echocardiography]] may demonstrate endomyocardial thickening, ventricular [[thrombus]] formation, and mitral valve involvment.<ref>{{Cite journal
*[[Echocardiography]] may demonstrate endomyocardial thickening, ventricular [[thrombus]] formation, and mitral valve involvement.<ref>{{Cite journal
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
Line 700: Line 700:


=== Other Diagnostic Studies ===
=== Other Diagnostic Studies ===
*Eosinophilic Cardiomyopathy may also be diagnosed using [[ECG]].<ref>{{Cite journal
*Eosinophilic cardiomyopathy may also be diagnosed using [[ECG]].<ref>{{Cite journal
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
Line 727: Line 727:
== Treatment ==
== Treatment ==
=== Medical Therapy ===
=== Medical Therapy ===
*The treatment of Eosinophilic Cardiomyopathy depends on the underlying cause.
*The treatment of eosinophilic cardiomyopathy depends on the underlying cause.
*The mainstay of therapy is supportive care.  
*The mainstay of therapy is supportive care.  
*The mainstay of therapy for Eosinophilic Cardiomyopathy with a FIP1L1-PDGFRA  mutation is [[imatinib]] and [[steroids]].<ref>{{Cite journal
*The mainstay of therapy for eosinophilic cardiomyopathy with a FIP1L1-PDGFRA  mutation is [[imatinib]] and [[steroids]].<ref>{{Cite journal
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
Line 741: Line 741:
  | pmid = 17868859
  | pmid = 17868859
}}</ref>
}}</ref>
*Symptomatic management includes [[diuretics]], [[Beta Blockers]], [[ACE inhibitors]], [[Angiotensin Receptor Blockers]], and [[Digoxin]].<ref>{{Cite journal
*Symptomatic management includes [[Diuretics]], [[Beta Blockers]], [[ACE inhibitors]], [[Angiotensin Receptor Blockers]], and [[Digoxin]].<ref>{{Cite journal
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
Line 791: Line 791:
=== Surgery ===
=== Surgery ===


*[[Valve replacement]] may be performed for patients with valvular damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
*[[Valve replacement]] may be performed for patients with valvular damage in eosinophilic cardiomyopathy.<ref>{{Cite journal
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | author = [[Princess U. Ogbogu]], [[Douglas R. Rosing]] & [[McDonald K. 3rd Horne]]
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
  | title = Cardiovascular manifestations of hypereosinophilic syndromes
Line 803: Line 803:
  | pmid = 17868859
  | pmid = 17868859
}}</ref>
}}</ref>
*Cardiac [[Transplant]] may be performed for patients with irreversible damage in Eosinophilic Cardiomyopathy.<ref>{{Cite journal
*Cardiac [[transplant]] may be performed for patients with irreversible damage in eosinophilic cardiomyopathy.<ref>{{Cite journal
  | author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
  | author = [[Sharon Ann Hunt]], [[William T. Abraham]], [[Marshall H. Chin]], [[Arthur M. Feldman]], [[Gary S. Francis]], [[Theodore G. Ganiats]], [[Mariell Jessup]], [[Marvin A. Konstam]], [[Donna M. Mancini]], [[Keith Michl]], [[John A. Oates]], [[Peter S. Rahko]], [[Marc A. Silver]], [[Lynne Warner Stevenson]], [[Clyde W. Yancy]], [[Elliott M. Antman]], [[Sidney C. Jr Smith]], [[Cynthia D. Adams]], [[Jeffrey L. Anderson]], [[David P. Faxon]], [[Valentin Fuster]], [[Jonathan L. Halperin]], [[Loren F. Hiratzka]], [[Alice K. Jacobs]], [[Rick Nishimura]], [[Joseph P. Ornato]], [[Richard L. Page]] & [[Barbara Riegel]]
  | title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
  | title = ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society
Line 817: Line 817:


=== Prevention ===
=== Prevention ===
*There are no primary preventive measures available for Eosinophilic Cardiomyopathy.
*There are no primary preventive measures available for eosinophilic cardiomyopathy.
   
   
*Once diagnosed and successfully treated, patients with Eosinophilic Cardiomyopathy are followed-up. Follow-up testing includes [[Echocardiography]] and [[Electrocardiogram]].<ref>{{Cite journal
*Once diagnosed and successfully treated, patients with eosinophilic cardiomyopathy are followed-up. Follow-up testing includes [[Echocardiography]] and [[Electrocardiogram]].<ref>{{Cite journal
  | author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
  | author = [[Paulo Dinis]], [[Rogerio Teixeira]], [[Luis Puga]], [[Carolina Lourenco]], [[Maria Carmo Cachulo]] & [[Lino Goncalves]]
  | title = Eosinophilic Myocarditis: Clinical Case and Literature Review
  | title = Eosinophilic Myocarditis: Clinical Case and Literature Review

Revision as of 19:16, 21 May 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of restrictive cardiomyopathy caused by eosinophillic infiltration of the endomyocardium.[1] It is a feature of hypereosinophilic syndrome and occurs in 40-50% of all cases. Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines. This process leads to tissue damage and dysfunction, eventually leading to fibrosis and restrictive cardiomyopathy. There are 3 stages of the eosinophilic cardiomyopathy: Stage 1 that is acute necrotic stage, stage 2 that is mural thrombi/ thrombus formation, and stage 3 that is ibrotic stage. There are many causes of hypereosinophilic syndrome (HES) with eosinophilic cardiomyopathy, these can be classified as reactive, conal myeloid disorder, and idiopathic hypereosinophillic syndrome.

Historical Perspective

  • Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936 during/following [event].[2] [3]

Classification

  • Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:[4][5]

Pathophysiology

  • The pathogenesis of eosinophilic cadiomyopathy is characterized by hypereosinophilia [12], thrombi formation [13], restrictive cardiomyopathy[14] [15], and heart failure [16].[17]
  • The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic leukemia [18]and hypereosiniophilic syndrome.[19] [20]
  • The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.[21] [22]
  • On gross pathology, cardiac hypertrophy and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.[23]
  • On microscopic histopathological analysis, hypereosinophilia, myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.[24]

Clinical Features

Differentiating [disease name] from other Diseases

Epidemiology and Demographics

Age

  • Patients of all age groups may develop ecosinophilic cardiomyopathy.[35]
  • Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.[36]

Gender

  • Men are more commonly affected with eosinophilic cadiomyopathy than Females.[37]
  • The male to female ratio is approximately 1.47. [38]

Race

  • There is no racial predilection for eosinophilic cardiomyopathy.

Risk Factors

Natural History, Complications and Prognosis

  • Prognosis is generally good, and depends on its etiology.[43]

Diagnosis

Diagnostic Criteria

  • an elevated eosinophil count (>1500/mm3) on 2 separate tests (≥1 mo)
  • tissue hypereosinophilia based on >20% eosinophils in a bone marrow section
  • marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia

Symptoms

Physical Examination

Laboratory Findings

Imaging Findings

  • Cardiac MRI is the imaging diagnostic study of choice for eosinophilic cardiomyopathy.[54]
  • On cardiac MRI, eosinophilic cardiomyopathy is characterized by hyper-enhancement and thrombus formation. [55]
  • Echocardiography may demonstrate endomyocardial thickening, ventricular thrombus formation, and mitral valve involvement.[56]

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

  • Valve replacement may be performed for patients with valvular damage in eosinophilic cardiomyopathy.[64]
  • Cardiac transplant may be performed for patients with irreversible damage in eosinophilic cardiomyopathy.[65]

Prevention

  • There are no primary preventive measures available for eosinophilic cardiomyopathy.

References

  1. ↑ Christopher C. Cheung, Maggie Constantine, Amir Ahmadi, Carolyn Shiau & Luke Y. C. Chen (2017). "Eosinophilic Myocarditis". The American journal of the medical sciences. 354 (5): 486–492. doi:10.1016/j.amjms.2017.04.002. PMID 29173361. Unknown parameter |month= ignored (help)
  2. ↑ Christopher C. Cheung, Maggie Constantine, Amir Ahmadi, Carolyn Shiau & Luke Y. C. Chen (2017). "Eosinophilic Myocarditis". The American journal of the medical sciences. 354 (5): 486–492. doi:10.1016/j.amjms.2017.04.002. PMID 29173361. Unknown parameter |month= ignored (help)
  3. ↑ Amit Alam, Shankar Thampi, Shahryar G. Saba & Rita Jermyn (2017). "Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis". Clinical medicine insights. Case reports. 10: 1179547617723643. doi:10.1177/1179547617723643. PMID 28890659.
  4. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  5. ↑ Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter |month= ignored (help)
  6. ↑ Christopher C. Cheung, Maggie Constantine, Amir Ahmadi, Carolyn Shiau & Luke Y. C. Chen (2017). "Eosinophilic Myocarditis". The American journal of the medical sciences. 354 (5): 486–492. doi:10.1016/j.amjms.2017.04.002. PMID 29173361. Unknown parameter |month= ignored (help)
  7. ↑ Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter |month= ignored (help)
  8. ↑ Christopher C. Cheung, Maggie Constantine, Amir Ahmadi, Carolyn Shiau & Luke Y. C. Chen (2017). "Eosinophilic Myocarditis". The American journal of the medical sciences. 354 (5): 486–492. doi:10.1016/j.amjms.2017.04.002. PMID 29173361. Unknown parameter |month= ignored (help)
  9. ↑ Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter |month= ignored (help)
  10. ↑ Christopher C. Cheung, Maggie Constantine, Amir Ahmadi, Carolyn Shiau & Luke Y. C. Chen (2017). "Eosinophilic Myocarditis". The American journal of the medical sciences. 354 (5): 486–492. doi:10.1016/j.amjms.2017.04.002. PMID 29173361. Unknown parameter |month= ignored (help)
  11. ↑ Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter |month= ignored (help)
  12. ↑ Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter |month= ignored (help)
  13. ↑ Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter |month= ignored (help)
  14. ↑ Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter |month= ignored (help)
  15. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  16. ↑ Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter |month= ignored (help)
  17. ↑ M. Arima & T. Kanoh (1999). "Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP". Heart (British Cardiac Society). 81 (6): 669–671. PMID 10336931. Unknown parameter |month= ignored (help)
  18. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  19. ↑ Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter |month= ignored (help)
  20. ↑ Jason Gotlib (2015). "World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management". American journal of hematology. 90 (11): 1077–1089. doi:10.1002/ajh.24196. PMID 26486351. Unknown parameter |month= ignored (help)
  21. ↑ Christopher C. Cheung, Maggie Constantine, Amir Ahmadi, Carolyn Shiau & Luke Y. C. Chen (2017). "Eosinophilic Myocarditis". The American journal of the medical sciences. 354 (5): 486–492. doi:10.1016/j.amjms.2017.04.002. PMID 29173361. Unknown parameter |month= ignored (help)
  22. ↑ Jason Gotlib (2015). "World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management". American journal of hematology. 90 (11): 1077–1089. doi:10.1002/ajh.24196. PMID 26486351. Unknown parameter |month= ignored (help)
  23. ↑ Gustav Mattsson & Peter Magnusson (2017). "Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids". BMC cardiovascular disorders. 17 (1): 299. doi:10.1186/s12872-017-0734-8. PMID 29262787. Unknown parameter |month= ignored (help)
  24. ↑ A. Angelini, V. Calzolari, G. Thiene, G. M. Boffa, M. Valente, L. Daliento, C. Basso, F. Calabrese, R. Razzolini, U. Livi & R. Chioin (1997). "Morphologic spectrum of primary restrictive cardiomyopathy". The American journal of cardiology. 80 (8): 1046–1050. PMID 9352976. Unknown parameter |month= ignored (help)
  25. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  26. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  27. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  28. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  29. ↑ Nooreen Hussain, Preeti Patel, Jonathan Yin, Rachael Davis & Ossama Ikladios (2019). "A case of Loeffler's endocarditis after initiation of adalimumab". Journal of community hospital internal medicine perspectives. 9 (1): 29–32. doi:10.1080/20009666.2018.1562852. PMID 30788072.
  30. ↑ Petar M. Seferovic, Marija Polovina, Johann Bauersachs, Michael Arad, Tuvia Ben Gal, Lars H. Lund, Stephan B. Felix, Eloisa Arbustini, Alida L. P. Caforio, Dimitrios Farmakis, Gerasimos S. Filippatos, Elias Gialafos, Vladimir Kanjuh, Gordana Krljanac, Giuseppe Limongelli, Ales Linhart, Alexander R. Lyon, Ruzica Maksimovic, Davor Milicic, Ivan Milinkovic, Michel Noutsias, Ali Oto, Oztekin Oto, Sinisa U. Pavlovic, Massimo F. Piepoli, Arsen D. Ristic, Giuseppe M. C. Rosano, Hubert Seggewiss, Milika Asanin, Jelena P. Seferovic, Frank Ruschitzka, Jelena Celutkiene, Tiny Jaarsma, Christian Mueller, Brenda Moura, Loreena Hill, Maurizio Volterrani, Yuri Lopatin, Marco Metra, Johannes Backs, Wilfried Mullens, Ovidiu Chioncel, Rudolf de Boer, Stefan Anker, Claudio Rapezzi, Andrew J. S. Coats & Carsten Tschope (2019). "Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology". European journal of heart failure. doi:10.1002/ejhf.1461. PMID 30989768. Unknown parameter |month= ignored (help)
  31. ↑ Adeyemi Adedamola Taiwo, Lavanya Alapati & Assad Movahed (2019). "Cardiac amyloidosis: A case report and review of literature". World journal of clinical cases. 7 (6): 742–752. doi:10.12998/wjcc.v7.i6.742. PMID 30968039. Unknown parameter |month= ignored (help)
  32. ↑ Jian Liang Tan & Sandeep K. Sharma (2018). "Cardiac sarcoidosis presenting with syncope and rapidly progressive atrioventricular block: a case report". European heart journal. Case reports. 2 (4): yty103. doi:10.1093/ehjcr/yty103. PMID 31020179. Unknown parameter |month= ignored (help)
  33. ↑ Kristen N.. Brown & Rene R.. Diaz (2019). "Restrictive (Infiltrative) Cardiomyopathy". PMID 30725919. Unknown parameter |month= ignored (help)
  34. ↑ Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter |month= ignored (help)
  35. ↑ Jason Gotlib (2015). "World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management". American journal of hematology. 90 (11): 1077–1089. doi:10.1002/ajh.24196. PMID 26486351. Unknown parameter |month= ignored (help)
  36. ↑ Jason Gotlib (2015). "World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management". American journal of hematology. 90 (11): 1077–1089. doi:10.1002/ajh.24196. PMID 26486351. Unknown parameter |month= ignored (help)
  37. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  38. ↑ Jason Gotlib (2015). "World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management". American journal of hematology. 90 (11): 1077–1089. doi:10.1002/ajh.24196. PMID 26486351. Unknown parameter |month= ignored (help)
  39. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  40. ↑ Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter |month= ignored (help)
  41. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  42. ↑ Paulo Dinis, Rogerio Teixeira, Luis Puga, Carolina Lourenco, Maria Carmo Cachulo & Lino Goncalves (2018). "Eosinophilic Myocarditis: Clinical Case and Literature Review". Arquivos brasileiros de cardiologia. 110 (6): 597–599. doi:10.5935/abc.20180089. PMID 30226920. Unknown parameter |month= ignored (help)
  43. ↑ Paulo Dinis, Rogerio Teixeira, Luis Puga, Carolina Lourenco, Maria Carmo Cachulo & Lino Goncalves (2018). "Eosinophilic Myocarditis: Clinical Case and Literature Review". Arquivos brasileiros de cardiologia. 110 (6): 597–599. doi:10.5935/abc.20180089. PMID 30226920. Unknown parameter |month= ignored (help)
  44. ↑ Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter |month= ignored (help)
  45. ↑ Peter Valent, Amy D. Klion, Hans-Peter Horny, Florence Roufosse, Jason Gotlib, Peter F. Weller, Andrzej Hellmann, Georgia Metzgeroth, Kristin M. Leiferman, Michel Arock, Joseph H. Butterfield, Wolfgang R. Sperr, Karl Sotlar, Peter Vandenberghe, Torsten Haferlach, Hans-Uwe Simon, Andreas Reiter & Gerald J. Gleich (2012). "Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes". The Journal of allergy and clinical immunology. 130 (3): 607–612. doi:10.1016/j.jaci.2012.02.019. PMID 22460074. Unknown parameter |month= ignored (help)
  46. ↑ Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter |month= ignored (help)
  47. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  48. ↑ Petar M. Seferovic, Marija Polovina, Johann Bauersachs, Michael Arad, Tuvia Ben Gal, Lars H. Lund, Stephan B. Felix, Eloisa Arbustini, Alida L. P. Caforio, Dimitrios Farmakis, Gerasimos S. Filippatos, Elias Gialafos, Vladimir Kanjuh, Gordana Krljanac, Giuseppe Limongelli, Ales Linhart, Alexander R. Lyon, Ruzica Maksimovic, Davor Milicic, Ivan Milinkovic, Michel Noutsias, Ali Oto, Oztekin Oto, Sinisa U. Pavlovic, Massimo F. Piepoli, Arsen D. Ristic, Giuseppe M. C. Rosano, Hubert Seggewiss, Milika Asanin, Jelena P. Seferovic, Frank Ruschitzka, Jelena Celutkiene, Tiny Jaarsma, Christian Mueller, Brenda Moura, Loreena Hill, Maurizio Volterrani, Yuri Lopatin, Marco Metra, Johannes Backs, Wilfried Mullens, Ovidiu Chioncel, Rudolf de Boer, Stefan Anker, Claudio Rapezzi, Andrew J. S. Coats & Carsten Tschope (2019). "Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology". European journal of heart failure. doi:10.1002/ejhf.1461. PMID 30989768. Unknown parameter |month= ignored (help)
  49. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  50. ↑ Petar M. Seferovic, Marija Polovina, Johann Bauersachs, Michael Arad, Tuvia Ben Gal, Lars H. Lund, Stephan B. Felix, Eloisa Arbustini, Alida L. P. Caforio, Dimitrios Farmakis, Gerasimos S. Filippatos, Elias Gialafos, Vladimir Kanjuh, Gordana Krljanac, Giuseppe Limongelli, Ales Linhart, Alexander R. Lyon, Ruzica Maksimovic, Davor Milicic, Ivan Milinkovic, Michel Noutsias, Ali Oto, Oztekin Oto, Sinisa U. Pavlovic, Massimo F. Piepoli, Arsen D. Ristic, Giuseppe M. C. Rosano, Hubert Seggewiss, Milika Asanin, Jelena P. Seferovic, Frank Ruschitzka, Jelena Celutkiene, Tiny Jaarsma, Christian Mueller, Brenda Moura, Loreena Hill, Maurizio Volterrani, Yuri Lopatin, Marco Metra, Johannes Backs, Wilfried Mullens, Ovidiu Chioncel, Rudolf de Boer, Stefan Anker, Claudio Rapezzi, Andrew J. S. Coats & Carsten Tschope (2019). "Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology". European journal of heart failure. doi:10.1002/ejhf.1461. PMID 30989768. Unknown parameter |month= ignored (help)
  51. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  52. ↑ Jason Gotlib (2015). "World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management". American journal of hematology. 90 (11): 1077–1089. doi:10.1002/ajh.24196. PMID 26486351. Unknown parameter |month= ignored (help)
  53. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  54. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  55. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  56. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  57. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  58. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  59. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  60. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  61. ↑ Sharon Ann Hunt, William T. Abraham, Marshall H. Chin, Arthur M. Feldman, Gary S. Francis, Theodore G. Ganiats, Mariell Jessup, Marvin A. Konstam, Donna M. Mancini, Keith Michl, John A. Oates, Peter S. Rahko, Marc A. Silver, Lynne Warner Stevenson, Clyde W. Yancy, Elliott M. Antman, Sidney C. Jr Smith, Cynthia D. Adams, Jeffrey L. Anderson, David P. Faxon, Valentin Fuster, Jonathan L. Halperin, Loren F. Hiratzka, Alice K. Jacobs, Rick Nishimura, Joseph P. Ornato, Richard L. Page & Barbara Riegel (2005). "ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society". Circulation. 112 (12): e154–e235. doi:10.1161/CIRCULATIONAHA.105.167586. PMID 16160202. Unknown parameter |month= ignored (help)
  62. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  63. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  64. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter |month= ignored (help)
  65. ↑ Sharon Ann Hunt, William T. Abraham, Marshall H. Chin, Arthur M. Feldman, Gary S. Francis, Theodore G. Ganiats, Mariell Jessup, Marvin A. Konstam, Donna M. Mancini, Keith Michl, John A. Oates, Peter S. Rahko, Marc A. Silver, Lynne Warner Stevenson, Clyde W. Yancy, Elliott M. Antman, Sidney C. Jr Smith, Cynthia D. Adams, Jeffrey L. Anderson, David P. Faxon, Valentin Fuster, Jonathan L. Halperin, Loren F. Hiratzka, Alice K. Jacobs, Rick Nishimura, Joseph P. Ornato, Richard L. Page & Barbara Riegel (2005). "ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society". Circulation. 112 (12): e154–e235. doi:10.1161/CIRCULATIONAHA.105.167586. PMID 16160202. Unknown parameter |month= ignored (help)
  66. ↑ Paulo Dinis, Rogerio Teixeira, Luis Puga, Carolina Lourenco, Maria Carmo Cachulo & Lino Goncalves (2018). "Eosinophilic Myocarditis: Clinical Case and Literature Review". Arquivos brasileiros de cardiologia. 110 (6): 597–599. doi:10.5935/abc.20180089. PMID 30226920. Unknown parameter |month= ignored (help)

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