Heart and Vessels

, Volume 1, Supplement 1, pp 240–242 | Cite as

Eosinophilic disorders affecting the myocardium and endocardium: A review

  • Christopher J. F. Spry
  • Machiko Take
  • Po-Chun Tai
Other Myocardial Disease

Summary

A wide range of disorders give rise to eosinophil counts >1.5×109/l (hypereosinophilia) and cardiac injury. The best known of these is eosinophilic endomyocardial disease (Löffler's endomyocardial fibrosis), which occurs as a major complication of the idiopathic hypereosinophilic syndrome. Here the heart damage appears to be a direct result of tissue injury produced by toxic eosinophil granule proteins within the heart. However, it is not known what causes the eosinophilia in these patients, why the eosinophils degranulate, or why the endocardium is especially susceptible to this type of injury. A number of parasitic infections may give rise to eosinophilic myocarditis. This is usually the result of the presence of the parasites within the myocardium where they die within inflammatory lesions, which may be extensive. Occasionally, drug reactions and rejection of a transplanted heart may produce eosinophilic myocarditis. Allergic granulomatosis and vasculitis (the Churg-Strauss syndrome), which gives rise to granulomas involving the myocardium, and eosinophilic (hypersensitivity) myocarditis usually respond rapidly to treatment with steroids. However, diffuse myocardial involvement may lead to heart failure, and some of these patients may later develop dilated cardiomyopathy. It is concluded that the heart may be affected by a variety of diseases in which eosinophils are a prominent component in the inflammatory cell infiltrates. Eosinophils themselves may contribute to some of the myocardial cell injury which occurs in these diseases, and attempts to limit this with steroids may be worthwhile in some patients.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Olsen EGJ, Spry CJF (1979) The pathogenesis of Löffler's endomyocardial disease and its relationship to endomyocardial filbrosis. Prog Cardiol 8: 281–303Google Scholar
  2. 2.
    Schooley RT, Parrillo JE, Wolff SM, Fauci AS (1980) Management of the idiopathic hypereosinophilic syndrome. In: Mahmoud AAF, Austen KF (eds) The eosinophil in health and disease. Grune and Stratton, New York, pp 323–339Google Scholar
  3. 3.
    Solley GO, Maldonado J, Gleich GJ, Giuliani ER, Hoagland HC, Pierre RV, Brown AL (1976) Endomyocardiopathy with eosinophilia. Mayo Clin Proc 51: 697–708Google Scholar
  4. 4.
    Davies J, Spry CJF, Sapsford R, Olsen EGJ, de Perez G, Oakley CM, Goodwin JF (1983) Cardiovascular features of eleven patients with eosinophilic endomyocardial disease. Quart J Med 52: 23–39Google Scholar
  5. 5.
    Parrillo JE, Borer JS, Henry WL, Wolff SM, Fauci AS (1979) The cardiovascular manifestations of the hypereosinophilic syndrome. Prospective study of 26 patients with review of the literature. Am J Med 67: 572–582Google Scholar
  6. 6.
    Davies J, Spry CJF, Vijayaraghavan G, de-Souza JA (1983) A comparison of the clinical and cardiological features of endomyocardial disease in temperate and tropical regions. Postgrad Med J 59: 179–183Google Scholar
  7. 7.
    Olsen EGJ, Spry CJF (1985) Relation between eosinophilia and endomyocardial disease. Prog Cardiovasc Dis 27: 241–254Google Scholar
  8. 8.
    Patel AK, D'Arbela PG, Somers K (1977) Endomyocardial fibrosis and eosinophilia. Br Heart J 39: 238–241Google Scholar
  9. 9.
    Vijayaraghavan G, Davies J, Sadanandan S, Spry CJF (1983) Echocardiographic features of tropical endomyocardial disease in South India. Br Heart J 50: 450–459Google Scholar
  10. 10.
    Andy JJ, O'Connell JP, Daddario RC, Roberts WC (1977) Trichinosis causing extensive ventricular mural endocarditis with superimposed thrombosis. Evidence that severe eosinophilia damages endocardium. Am J Med 63: 824–829Google Scholar
  11. 11.
    TaiP-C, Holt ME, Denny P, Gibbs AR, Williams BD, Spry CJF (1984) Deposition of eosinophil cationic protein in granulomas in allergic granulomatosis and vasculitis: the Churg-Strauss syndrome. Br Med J (Clin Res) 289: 400–402Google Scholar
  12. 12.
    Herzog CA, Snover DC, Staley NA (1984) Acute necrotising eosinophilic myocarditis. Br Heart J 52: 343–348Google Scholar
  13. 13.
    Spry CJF (1980) Eosinophilia and allergic reactions to drugs. Clin Haematol 9: 521–534Google Scholar
  14. 14.
    Spry CJF (1982) The hypereosinophilic syndrome: clinical features, laboratory findings and treatment. Allergy 37: 539–555Google Scholar
  15. 15.
    Spry CJF, Davies J, Tai P-C, Olsen EGJ, Oakley CM, Goodwin JF (1983) Clinical features of fifteen patients with the hypereosinophilic syndrome. Quart J Med 52: 1–22Google Scholar
  16. 16.
    Davies J, Gibson DG, Foale R, Heer K, Spry CJF, Oakley CM, Goodwin JF (1982) Echocardiographic features of eosinophilic endomyocardial disease. Br Heart J 48: 434–440Google Scholar
  17. 17.
    Cohen J, Davies J, Goodwin JF, Spry CJF (1981) Arrhythmias in patients with hypereosinophilia: a comparison of patients with and without Löffler's endomyocardial disease. Postgrad Med J 56: 828–832Google Scholar
  18. 18.
    Davies J, Sapsford R, Brooksby I, Olsen EGJ, Spry CJF, Oakley CM, Goodwin JF (1981) Successful surgical treatment of two patients with eosinophilic endomyocardial disease. Br Heart J 46: 73–81Google Scholar
  19. 19.
    Ishii T, Koide O, Hosoda Y, Takahashi R (1977) Hypereosinophilic multiple thrombosis. A proposal of a new designation of disseminated eosinophilic ‘collagen disease’. Angiology 28: 361–375Google Scholar
  20. 20.
    Chaine G, Davies J, Kohner EM, Hawarth S, Spry CJF (1982) Ophthalmologic abnormalities in the hypereosinophilic syndrome. Ophthalmology 89: 1348–1356Google Scholar
  21. 21.
    Brockington IF, Olsen EGJ (1973) Löffler's endocarditis and Davies' endomyocardial fibrosis. Am Heart J 85: 308–322Google Scholar
  22. 22.
    Spry CJF, Tai P-C, Davies J, Olsen EGJ, Goodwin JF (1984) The role of eosinophils in myocarditis. In: Bolte H-D (ed) Viral heart disease. Springer, Berlin Heidelberg New York TokyoGoogle Scholar
  23. 23.
    Spry CJF, Weetman AP, Olsson I, Olsen EGJ (1985) Eosinophilic myocardial disease as a complication of carcinoma of the lung induced hypereosinophilia. In: Sekiguchi M, Olsen EGJ, Goodwin in JF (eds) Myocarditis and related disorders. Heart and Vessels (Suppl 1): 312 (Abstract)Google Scholar
  24. 24.
    Slungaard A, Ascensao J, Zanjani E, Jacob HS (1983) Pulmonary carcinoma with eosinophilia. Demonstration of a tumor-derived eosinophilopoietic factor. New Engl J Med 309: 778–781Google Scholar
  25. 25.
    Tai P-C, Spry CJF, Olsen EGJ, Ackerman SJ, Dunnette S, Gleich GJ (submitted for publication) Eosinophil granule proteins in cardiac tissues from patients with eosinophilic endomyocardial disease.Google Scholar
  26. 26.
    Spry CJF, Tai P-C (1976) Studies on blood eosinophils. II. Patients with Löffler's cardiomyopathy. Clin Exp Immunol 24: 423–434Google Scholar
  27. 27.
    Wassom DL, Loegering DA, Solley GO, Moore SB, Schooley RT, Fauci AS, Gleich GJ (1981) Elevated serum levels of the eosinophil granule major basic protein in patients with eosinophilia. J Clin Invest 67: 651–661Google Scholar
  28. 28.
    Tai P-C, Hayes DJ, Clark JB, Spry CJF (1982) Toxic effects of human eosinophil secretion products on isolated rat heart cells in vitro. Biochem J 204: 75–80Google Scholar
  29. 29.
    Winqvist I, Olofsson T, Olsson I (1984) Mechanisms for eosinophil degranulation; release of the eosinophil cationic protein. Immunology 51: 1–8Google Scholar
  30. 30.
    Tai P-C, Spry CJF, Bakes DM, Barkans JR (1985) Eosinophil membrane antigens: Phenotypic frequencies in normal individuals and in patients with the hypereosinophilic syndrome. Int Arch Allerg Appl ImmunolGoogle Scholar
  31. 31.
    Tai P-C, Bakes DM, Barkans JR, Spry CJF (1985) (in press) Plasma membrane antigens on light density and activated human blood eosinophies. Clin Exp ImmunolGoogle Scholar
  32. 32.
    Lopez AF, Vadas MA (1984) Stimulation of human granulocyte function by monoclonal antibody WEM-G1. Proc Natl Acad Sci USA 81: 1818–1822Google Scholar

Copyright information

© Springer-Verlag 1985

Authors and Affiliations

  • Christopher J. F. Spry
    • 1
  • Machiko Take
    • 1
  • Po-Chun Tai
    • 1
  1. 1.Departments of Immunology and MedicineHammersmith Hospital and Royal Postgraduate Medical SchoolLondonUK

Personalised recommendations