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. Data are available on reasonable request.

中文翻译：

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嗜酸性粒细胞性心肌炎：系统评价

目的 在临床实践中，嗜酸性粒细胞性心肌炎（EM）患者可能会放弃金标准诊断程序——心内膜心肌活检（EMB），尽管指南强烈推荐这样做。本系统综述旨在总结当前诊断和治疗 EM 的方法，特别强调替代诊断方法的利用和价值。方法 按照系统评价和荟萃分析声明的首选报告项目，我们使用关键词“嗜酸粒细胞性心肌炎”在 MEDLINE 和 EMBASE 上搜索了所有同行评审文章，从文章开始到 2022 年 9 月 10 日。结果 我们纳入了 239 篇文章，其中包括 8 篇观察性文章本次综述中涉及研究和 274 个案例。患者中位年龄为 45 岁。最初的表现是非特异性的，包括呼吸困难（50.0%）和胸痛（39.4%）。 EM 的病因多种多样，最常见的是特发性（28.8%）和嗜酸性肉芽肿性多血管炎（19.3%）；其他包括药物引起的（13.1%）和嗜酸性粒细胞增多综合征（12.8%）。 82.4% 的人接受了 EMB 的 EM 诊断，而 17.6% 的人根据临床推理和心脏 MRI (CMR) 进行诊断。 CMR 诊断的患者在诊断时表现出更好的风险状况，特别是左心室射血分数较高，并且对正性肌力或机械循环支持的需求较少。糖皮质激素是主要治疗方法，剂量和方案各不相同。结论 EMB 是 EM 诊断检测的支柱。 CMR 可能有助于在适当的临床情况下进行筛查。关于治疗，对于皮质类固醇的最佳剂量尚未达成共识。有必要进行大型临床试验来进一步探索 CMR 在诊断 EM 中的效用以及类固醇疗法在治疗 EM 中的效用。可根据合理要求提供数据。