ABSTRACT
Eosinophilic granulomatosis with polyangiitis, formerly known as Churg-Strauss Syndrome, is a rare pathology that belongs to the group of diseases characterized by necrotizing vasculitis of small and medium-sized systemic blood vessels. Symptomatic cardiovascular involvement occurs in 27% to 47% of Churg-Strauss cases, being one of the most serious manifestations. The diagnosis is usually confirmed with tissue biopsy showing eosinophil infiltration, but in selected cases with the recent inclusion of cardiac MRI, we can dispense with it. Early diagnosis is important because early treatment is usually associated with improvement in the condition.
La granulomatosis eosinofílica con poliangeítis, anteriormente conocida como síndrome de Churg-Strauss, es una patología poco frecuente que pertenece al grupo de enfermedades caracterizadas por vasculitis necrotizante de vasos sanguíneos sistémicos de pequeño y mediano calibre. La afectación cardiovascular sintomática ocurre entre un 27% a un 47% de los casos de Churg-Strauss, siendo una de las manifestaciones más graves. El diagnóstico suele confirmarse con biopsia de tejido con infiltración de eosinófilos, pero con la reciente inclusión de la resonancia cardíaca, podemos prescindir de ella. El diagnóstico precoz es importante debido a que el tratamiento oportuno suele asociarse con mejoría del cuadro.
Subject(s)
Cardiomyopathy, Dilated , Churg-Strauss Syndrome , Granulomatosis with Polyangiitis , Humans , Retrospective StudiesABSTRACT
BACKGROUND: Diagnosing non-ST-segment elevation acute coronary syndrome (NSTE-ACS) is not always straightforward. Left ventricular global longitudinal strain (LVGLS) is an echocardiographic method capable of detecting subclinical regional and global ventricular contractile dysfunction due to myocardial ischemia. The objectives of this study were to evaluate the efficacy of LVGLS in diagnosing severe coronary disease in patients with chest pain suggestive of NSTE-ACS and to assess the relationships between LVGLS reduction and ultrasensitive troponin T (UsTnT) elevation, electrocardiographic changes suggestive of ischemia, and the number of vessels with severe obstructions. METHODS: This prospective, observational study evaluated hospitalized patients with chest pain of presumed coronary etiology. All patients underwent electrocardiography (ECG), UsTnT measurement, Doppler echocardiography, LVGLS measurement, and coronary angiography Coronary angiogram (CA) within 48 h of hospitalization. RESULTS: A total of 75 patients with a mean age of 58 ± 17 years were included, of whom 84% (63 patients) were men. An LVGLS value of <-16.5, as determined by the Youden index proved to be useful for the detection of severe coronary obstructions (lesions >70%). The sensitivity, specificity, and positive and negative predictive values were 96%, 88%, 92%, and 92%, respectively. The number of coronary arteries involved had a direct relationship with the degree of LVGLS reduction (P < 0.001). Elevated UsTnT levels occurred more frequently in patients with reduced LVGLS than in those with normal LVGLS (83% vs. 17%, P < 0.0001). Abnormal strain was not associated with electrocardiographic changes suggestive of ischemia. CONCLUSIONS: LVGLS measurement in patients with presumed NSTE-ACS is efficient in predicting the presence of severe coronary disease. The number of coronary arteries involved has a direct relationship with the degree of LVGLS reduction. Abnormal strain is associated with UsTnT elevations but not with electrocardiographic changes suggestive of ischemia.
