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Systematic review
Eosinophilic myocarditis: systematic review
  1. Witina Techasatian1,
  2. Maan Gozun1,
  3. Kristine Vo1,
  4. Jennifer Yokoyama1,
  5. Todd Nagamine1,
  6. Parthav Shah1,
  7. Kimberly Vu2,
  8. James Zhang2,
  9. Yoshito Nishimura1
  1. 1Department of Medicine, UH Mānoa JABSOM, Honolulu, Hawaii, USA
  2. 2Queen's Heart Institute, Queen's Medical Center, Honolulu, Hawaii, USA
  1. Correspondence to Dr Yoshito Nishimura, Medicine, UH Mānoa JABSOM, Honolulu, HI 96813, USA; yoshiton{at}


Objective In clinical practice, patients with eosinophilic myocarditis (EM) may forgo the gold standard diagnostic procedure, endomyocardial biopsy (EMB), although it is highly recommended in guidelines. This systematic review aims to summarise current approaches in diagnosing and treating EM with a particular emphasis on the utilisation and value of alternative diagnostic methods.

Methods Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement, we searched MEDLINE and EMBASE for all peer-reviewed articles using the keywords “eosinophilic myocarditis” from their inception to 10 September 2022.

Results We included 239 articles, including 8 observational studies and 274 cases, in this review. The median patient age was 45 years. Initial presentations were non-specific, including dyspnoea (50.0%) and chest pain (39.4%). The aetiologies of EM were variable with the most common being idiopathic (28.8%) and eosinophilic granulomatosis polyangiitis (19.3%); others included drug-induced (13.1%) and hypereosinophilic syndrome (12.8%). 82.4% received an EM diagnosis by EMB while 17.6% were diagnosed based on clinical reasoning and cardiac MRI (CMR). CMR-diagnosed patients exhibited a better risk profile at diagnosis, particularly higher left ventricular ejection fraction and less need for inotropic or mechanical circulatory supports. Glucocorticoids were the primary treatment with variability in dosages and regimens.

Conclusion EMB is the mainstay for diagnostic testing for EM. CMR is potentially helpful for screening in appropriate clinical scenarios. Regarding treatment, there is no consensus regarding the optimal dosage of corticosteroids. Large clinical trials are warranted to further explore the utility of CMR in the diagnosis of EM and steroid regimen in treating EM.

  • myocarditis
  • magnetic resonance imaging
  • systematic reviews as topic

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • Contributors YN conceived the study, searched the literature, assessed the quality of the studies, drafted and revised the manuscript and supervised the process. KVo searched the literature and assessed the quality of the studies. MG, TN, WT, JY, PS, KVu and JZ revised the manuscript. YN is the guarantor and accepts full responsibility for the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.