Palazzini, Matteo
https://orcid.org/0000-0003-1700-7340
Mayo Clinic
Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda
Citations 1
Natural History of Patients With Histologically Proven Acute Eosinophilic Myocarditis
Ammirati, Enrico, Palazzini, Matteo , Lehtonen, Jukka , Potena, Luciano , Mäyränpää, Mikko I. , Rågback, Johanna, Uribarri, Aitor , Thiele, H, Vidal‐Burdeus, María , Freund, Anne, Gustafsson, F., Tschöpe, C., Elsanhoury, Ahmed , Ihle, Joshua , Rudi, Wolf‐Stephan , Grabmaier, Ulrich , Merlo, Marco, Weislova, Ivana, Jellinghaus, Stefanie, Linke, A, Baldovini, Chiara , Adorisio, R, Kuchyňka, Petr, Palecek, T, Krejčí, Jan, Poloczková, Hana , Caterino, Anna Laura, Lovell, Jana , Macomb, Elaine P., Shih, Jeffrey, Hong, Kimberly N. , Ruschitzka, Frank, Cavallini, Claudio, Riccini, Clara, Kamal, Mohamed, Groh, Matthieu, Garascia, Andrea , Lala, Anuradha, Shimokawa, Hiroaki, Sionis, A, Schmidt, Matthieu, Grosu, Aurelia, Bollano, Entela , Turco, Annalisa , Crespo-Leiro, M., Couto-Mallón, David, Cannata, Antonio, Narducci, M L, Cicchitti, Vincenzo , Ianni, Umberto , L, De Luca, Frea, Simone, Schroeder, J. W., Arias, Aníbal , Emdin, Michele, Corda, Marco , Pasqualucci, Daniele , Greulich, Simon , Gawaz, M, Manuylova, Tatiana, Martinez-Selles, M, Pérez, Francisco José Hernández, Centellas, Alba Martín , Trankle, Cory R. , Halushka, Marc K., Abbate, Antonio, Basso, Cristina, Sinagra, Gianfranco, Veronese, Giacomo , Camici, PG, Adler, Eric D., Cooper, Leslie T., Gustafsson, Finn , Tschöpe, Carsten , Thiele, Hölger , Ammirati, Enrico , Potena, Luciano , Ammirati, Enrico , Foà, Alberto , Uribarri, Aitor , Thiele, Holger , Vidal-Burdeus, María , Freund, Anne , Gustafsson, Finn , Tschöpe, Carsten , Elsanhoury, Ahmed , Ihle, Joshua , Grabmaier, Ulrich , Merlo, Marco , Melenovský, Vojtěch , Weislova, Ivana , Linke, Axel , Baldovini, Chiara , Kuchynka, Petr , Krejčí, Jan , Gilotra, Nisha A , Hong, Kimberly , Rossi, Valentina A , Ruschitzka, Frank T. , Kamal, Mohamed , Huang, Florent , Groh, Matthieu , Gentile, Piero , Garascia, Andrea , Shimokawa, Hiroaki , Vandenbriele, Christophe , Sionis, Alessandro , Schmidt, Matthieu , Bollano, Entela , Crespo-Leiro, Maria Generosa , Cannatà, Antonio , Bromage, Daniel I , Narducci, Maria Lucia , Cicchitti, Vincenzo , Ianni, Umberto , De Luca, Leonardo , Mistrulli, Raffaella , Frea, Simone , Raineri, Claudia , Schroeder, Jan W , Arias, Anibal Martin , Emdin, Michele , Greulich, Simon , Gawaz, Meinrad , Martínez-Sellés, Manuel , Hernández Pérez, Francisco José , Dominguez, Fernando , D'Alessandris, Nicoletta , Trankle, Cory , Halushka, Marc K , Moroni, Francesco , Abbate, Antonio , Basso, Cristina , Sinagra, Gianfranco , Veronese, Giacomo , Camici, Paolo G , Adler, Eric D , Bernasconi, Davide P , Klingel, Karin , Cooper, Leslie T , Foà, Alberto , Vidal-Burdeus, María , Merlo, M, Melenovský, Vojtěch , Adorisio, Rachele , Paleček, Tomáš , Krejčí, Jan , Cavallini, Claudio , Riccini, Clara, Gentile, Piero , Lala, Anuradha , Shimokawa, Hiroaki , Vandenbriele, Christophe , Couto‐Mallón, David , Luca, Leonardo De , Frea, Simone , Corda, Marco , Domínguez, Fernándo , Gaillet, Antoine , Halushka, Marc K. , Abbate, Antonio , Basso, Cristina , Cooper, Leslie T.
Circulation | February 6, 2026 | Volume: 153 | Issue: 9 | Pages: 634-652
10.1161/circulationaha.125.074797
BACKGROUND: No large registries of patients with acute eosinophilic myocarditis (EM) are available. However, EM is perceived as a cardiac disease with high mortality, affecting mainly young and middle-aged adults according to small series and case reports. Awareness of the clinical presentation, associated systemic conditions, treatments, and outcomes of this uncommon condition is an unmet need. METHODS: In this international, multicenter, retrospective cohort study, 53 centers screened 193 patients with histologically proven acute EM between 1992 and 2023. After the exclusion of patients with insufficient data (n=10), symptoms lasting >30 days (n=19), or histological diagnosis not confirmed after review (n=8), 156 patients were included. RESULTS: Median age at presentation was 48 years (first to third quartile, 34–59 years) with male predominance (67.3%), and only 2 were pediatric cases (≤16 years of age; 1.3%). The main signs and symptoms at presentation were dyspnea (75.6%), fever (61.3%), and chest pain (53.2%). Unexpectedly, peripheral eosinophilia was reported in only 57.4% of cases, with a median cell count of 630 eosinophils/μL. The median left ventricular ejection fraction at presentation was 32% (first to third quartile, 25%–48%). The disorders most frequently associated with EM were eosinophilic granulomatosis with polyangiitis (22.4% of cases) and hypersensitivity forms (14.1%). Idiopathic/undefined forms accounted for 44.9% of cases, and miscellaneous causes accounted for 18.6%. In-hospital death or need for heart transplantation (HTx) occurred in 23 patients (14.7%; 22 deaths and 1 HTx), despite 43.6% being treated with temporary mechanical circulatory support and 92.9% being treated with immunosuppressive agents. Estimated rates of death or HTx at 1 and 3 years were 19.0% and 23.8%. Increased age, decreased left ventricular ejection fraction on admission, and no immunosuppressive therapy during hospitalization were independent predictors of death or HTx. A nonsignificant higher occurrence of deaths or HTx was observed in the hypersensitivity form (46.1%) compared with the eosinophilic granulomatosis with polyangiitis–associated form (13.1%) at 3 years ( P =0.15). CONCLUSIONS: Acute EM can often present without peripheral eosinophilia, and rates of in-hospital and midterm mortality or HTx are high. Endomyocardial biopsy is required to reach the final diagnosis of EM because relying on peripheral eosinophilia can lead to missing diagnosis. In-hospital immunosuppression is associated with HTx-free survival, although tailored immunosuppressive therapies are needed to improve outcomes. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT06447935.