Eosinophilic cardiomyopathy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

## Overview[edit | edit source]

Eosinophillic Cardiomyopathy also known as Loeffler's Syndrome is a type of restrictive cardiomyopathy caused by eosinophillic infiltration of the endomyocardium. It is a feature of hypereosinophilic syndrome and occurs in 40-50% of all cases. Eosinophills enter the tissue and undergo degranulation; release cytotoxic proteins; increase production of reactive oxygen species, enzymes, growth factor, and cytokines. This process leads to tissue damage and dysfunction, eventually leading to fibrosis and restrictive cardiomyopathy. There are 3 stages of the eosinophilic cardiomyopathy: Stage 1 that is acute necrotic stage, stage 2 that is mural thrombus formation, and stage 3 that is ibrotic stage. There are many causes of hypereosinophilic syndrome (HES) with eosinophilic cardiomyopathy, these can be classified as reactive, conal myeloid disorder, and idiopathic hypereosinophillic syndrome.

## Historical Perspective[edit | edit source]

* Eosinophillic Cardiomypoathy was first discovered by Wilhem Loeffler, a Swiss Physician, in 1936.[1] [2]

## Classification[edit | edit source]

* Eosinophilic Cardiomyopathy may be classified according to cause into three subtypes/groups:[3][4]

* Reactive[5] [6]
* Clonal myeloid disorder[7][8]
* Idiopathic hypereosinophillic syndrome [9][10]

## Pathophysiology[edit | edit source]

* The pathogenesis of eosinophilic cadiomyopathy is characterized by hypereosinophilia [11], thrombi formation [12], restrictive cardiomyopathy[13] [14], and heart failure [15].[16]
* The FLP1L1-PDGFRA fusion gene has been associated with the development chronic eosinophilic leukemia [17]and hypereosiniophilic syndrome.[18] [19]
* The PDGFRa, PDGFRb, and PDGFR1 genes have been associated with the development of clonal myeloid disorders leading to hypereosiniophilic syndrome.[20] [21]
* On gross pathology, cardiac hypertrophy and fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.[22]
* On microscopic histopathological analysis, hypereosinophilia, myocardial and myofibrillar disarray, and endoperimysial interstitial fibrosis are characteristic findings of Eosinophilic Cardiomyopathy.[23]

## Clinical Features[edit | edit source]

* Dyspnea[24]
* Chest pain[25]
* Cough[26]
* Embolic events[27]
* Fever [28]

## Differentiating [disease name] from other Diseases[edit | edit source]

* Eosinophilic cardiomyopathy must be differentiated from other diseases that cause cardiac hypertrophy, cardiac fibrosis, and heart failure[29], such as:

* Amyloidosis[30]
* Sarcoidosis[31]
* Hemachromatosis[32]

## Epidemiology and Demographics[edit | edit source]

* The prevalence of hypereosinophilic syndrome is approximately 0.036 per 100,000 individuals worldwide. [33]

### Age[edit | edit source]

* Patients of all age groups may develop ecosinophilic cardiomyopathy.[34]
* Eosinopilic cardiomyopathy is more commonly observed among patients aged 20-50 years old.[35]

### Gender[edit | edit source]

* Men are more commonly affected with eosinophilic cadiomyopathy than Females.[36]
* The male to female ratio is approximately 1.47. [37]

### Race[edit | edit source]

* There is no racial predilection for eosinophilic cardiomyopathy.

## Risk Factors[edit | edit source]

* Common risk factors in the development of eosinophilic cardiomyopathy are HLA Bw44 positivity, splenomegaly, thrombocytopenia, elevated vitamin B12 levels, dysplastic eosinophils, and abnormal early myeloid precursors.[38]

## Natural History, Complications and Prognosis[edit | edit source]

* Some patients with eosinophilic cardiomyopathy may present asymptomatic.[39]
* Early clinical features include dyspnea, fever, and chest pain.[40]
* If left untreated, patients with eosinophilic cardiomyopathy may progress to develop heart failure, arrythmias, and sudden cardiac death.[41]

* Prognosis is generally good, and depends on its etiology.[42]

## Diagnosis[edit | edit source]

### Diagnostic Criteria[edit | edit source]

* The diagnosis of hypereosinophilic syndrome is made when at least one of the following three diagnostic criteria are met:[43] [44]

* An elevated eosinophil count (>1500/mm3) on 2 separate tests (≥1 mo).
* Tissue hypereosinophilia based on >20% eosinophils in a bone marrow section.
* Marked disposition of eosinophilic granule proteins in tissue plus organ damage directly due to hypereosinophilia.

### Symptoms[edit | edit source]

* Eosinophilic cardiomyopathy is may present asymptomatic early in the course.[45]
* Symptoms of eosinophilc cardiomypoathy may include the following:[46] [47]
* Fever
* Dyspnea at rest or on exertion
* Chest pain
* Cough
* Rash
* Malaise

### Physical Examination[edit | edit source]

* Patients with eosinophilic cardiomyopathy usually appear distressed.
* Physical examination may be remarkable for:[48][49]
* Fever
* Tachycardia
* Tachypnea
* Arrythmia
* Rash
* Embolic events

### Laboratory Findings[edit | edit source]

* A positive cardiac biopsy is diagnostic of eosinophilic cardiomyopathy.[50]
* An elevated concentration of eosinophils in peripheral blood smear is diagnostic of hypereosinophilic syndrome.[51]
* Other laboratory findings consistent with the diagnosis of eosinophilic cardiomyopathy include:[52]
* Abnormal bone marrow biopsy
* Abnormal troponins

### Imaging Findings[edit | edit source]

* Cardiac MRI is the imaging diagnostic study of choice for eosinophilic cardiomyopathy.[53]
* On cardiac MRI, eosinophilic cardiomyopathy is characterized by hyper-enhancement and thrombus formation.[54]
* Echocardiography may demonstrate:[55]
* Endomyocardial thickening
* Ventricular thrombus formation
* Mitral valve involvement

### Other Diagnostic Studies[edit | edit source]

* Eosinophilic cardiomyopathy may also be diagnosed using ECG.[56]
* Findings on ECG include:[57]
* T wave inversion
* Left atrial enlargement
* Left ventricular hypertrophy
* Right bundle branch block

## Treatment[edit | edit source]

### Medical Therapy[edit | edit source]

* The treatment of eosinophilic cardiomyopathy depends on the underlying cause.
* The mainstay of therapy is supportive care.
* The mainstay of therapy for eosinophilic cardiomyopathy with a FIP1L1-PDGFRA mutation is imatinib and steroids.[58]
* Symptomatic management includes:[59] [60]
* Diuretics
* Beta Blockers
* ACE inhibitors
* Angiotensin Receptor Blockers
* Digoxin
* Imatinib acts by inhibition of tyrosine kinase.[61]
* Response to treatment can be monitored with Echocardiography.[62]

### Surgery[edit | edit source]

* Valve replacement may be performed for patients with valvular damage in eosinophilic cardiomyopathy.[63]
* Cardiac transplant may be performed for patients with irreversible damage in eosinophilic cardiomyopathy.[64]

### Prevention[edit | edit source]

* There are no primary preventive measures available for eosinophilic cardiomyopathy.

* Once diagnosed and successfully treated, patients with eosinophilic cardiomyopathy are followed-up. Follow-up testing includes Echocardiography and Electrocardiogram.[65]

## References[edit | edit source]

1. ↑ Christopher C. Cheung, Maggie Constantine, Amir Ahmadi, Carolyn Shiau & Luke Y. C. Chen (2017). "Eosinophilic Myocarditis". The American journal of the medical sciences. 354 (5): 486–492. doi:10.1016/j.amjms.2017.04.002. PMID 29173361. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link)
2. ↑ Amit Alam, Shankar Thampi, Shahryar G. Saba & Rita Jermyn (2017). "Loeffler Endocarditis: A Unique Presentation of Right-Sided Heart Failure Due to Eosinophil-Induced Endomyocardial Fibrosis". Clinical medicine insights. Case reports. 10: 1179547617723643. doi:10.1177/1179547617723643. PMID 28890659.CS1 maint: Multiple names: authors list (link)
3. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter `|month=` ignored (help)
4. ↑ Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link)
5. ↑ Christopher C. Cheung, Maggie Constantine, Amir Ahmadi, Carolyn Shiau & Luke Y. C. Chen (2017). "Eosinophilic Myocarditis". The American journal of the medical sciences. 354 (5): 486–492. doi:10.1016/j.amjms.2017.04.002. PMID 29173361. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link)
6. ↑ Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link)
7. ↑ Christopher C. Cheung, Maggie Constantine, Amir Ahmadi, Carolyn Shiau & Luke Y. C. Chen (2017). "Eosinophilic Myocarditis". The American journal of the medical sciences. 354 (5): 486–492. doi:10.1016/j.amjms.2017.04.002. PMID 29173361. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link)
8. ↑ Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link)
9. ↑ Christopher C. Cheung, Maggie Constantine, Amir Ahmadi, Carolyn Shiau & Luke Y. C. Chen (2017). "Eosinophilic Myocarditis". The American journal of the medical sciences. 354 (5): 486–492. doi:10.1016/j.amjms.2017.04.002. PMID 29173361. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link)
10. ↑ Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link)
11. ↑ Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link)
12. ↑ Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link)
13. ↑ Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link)
14. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter `|month=` ignored (help)
15. ↑ Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link)
16. ↑ M. Arima & T. Kanoh (1999). "Eosinophilic myocarditis associated with dense deposits of eosinophil cationic protein (ECP) in endomyocardium with high serum ECP". Heart (British Cardiac Society). 81 (6): 669–671. PMID 10336931. Unknown parameter `|month=` ignored (help)
17. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter `|month=` ignored (help)
18. ↑ Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link)
19. ↑ Jason Gotlib (2015). "World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management". American journal of hematology. 90 (11): 1077–1089. doi:10.1002/ajh.24196. PMID 26486351. Unknown parameter `|month=` ignored (help)
20. ↑ Christopher C. Cheung, Maggie Constantine, Amir Ahmadi, Carolyn Shiau & Luke Y. C. Chen (2017). "Eosinophilic Myocarditis". The American journal of the medical sciences. 354 (5): 486–492. doi:10.1016/j.amjms.2017.04.002. PMID 29173361. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link)
21. ↑ Jason Gotlib (2015). "World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management". American journal of hematology. 90 (11): 1077–1089. doi:10.1002/ajh.24196. PMID 26486351. Unknown parameter `|month=` ignored (help)
22. ↑ Gustav Mattsson & Peter Magnusson (2017). "Eosinophilic granulomatosis with polyangiitis: myocardial thickening reversed by corticosteroids". BMC cardiovascular disorders. 17 (1): 299. doi:10.1186/s12872-017-0734-8. PMID 29262787. Unknown parameter `|month=` ignored (help)
23. ↑ A. Angelini, V. Calzolari, G. Thiene, G. M. Boffa, M. Valente, L. Daliento, C. Basso, F. Calabrese, R. Razzolini, U. Livi & R. Chioin (1997). "Morphologic spectrum of primary restrictive cardiomyopathy". The American journal of cardiology. 80 (8): 1046–1050. PMID 9352976. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link)
24. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter `|month=` ignored (help)
25. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter `|month=` ignored (help)
26. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter `|month=` ignored (help)
27. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter `|month=` ignored (help)
28. ↑ Nooreen Hussain, Preeti Patel, Jonathan Yin, Rachael Davis & Ossama Ikladios (2019). "A case of Loeffler's endocarditis after initiation of adalimumab". Journal of community hospital internal medicine perspectives. 9 (1): 29–32. doi:10.1080/20009666.2018.1562852. PMID 30788072.CS1 maint: Multiple names: authors list (link)
29. ↑ Petar M. Seferovic, Marija Polovina, Johann Bauersachs, Michael Arad, Tuvia Ben Gal, Lars H. Lund, Stephan B. Felix, Eloisa Arbustini, Alida L. P. Caforio, Dimitrios Farmakis, Gerasimos S. Filippatos, Elias Gialafos, Vladimir Kanjuh, Gordana Krljanac, Giuseppe Limongelli, Ales Linhart, Alexander R. Lyon, Ruzica Maksimovic, Davor Milicic, Ivan Milinkovic, Michel Noutsias, Ali Oto, Oztekin Oto, Sinisa U. Pavlovic, Massimo F. Piepoli, Arsen D. Ristic, Giuseppe M. C. Rosano, Hubert Seggewiss, Milika Asanin, Jelena P. Seferovic, Frank Ruschitzka, Jelena Celutkiene, Tiny Jaarsma, Christian Mueller, Brenda Moura, Loreena Hill, Maurizio Volterrani, Yuri Lopatin, Marco Metra, Johannes Backs, Wilfried Mullens, Ovidiu Chioncel, Rudolf de Boer, Stefan Anker, Claudio Rapezzi, Andrew J. S. Coats & Carsten Tschope (2019). "Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology". European journal of heart failure. doi:10.1002/ejhf.1461. PMID 30989768. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link)
30. ↑ Adeyemi Adedamola Taiwo, Lavanya Alapati & Assad Movahed (2019). "Cardiac amyloidosis: A case report and review of literature". World journal of clinical cases. 7 (6): 742–752. doi:10.12998/wjcc.v7.i6.742. PMID 30968039. Unknown parameter `|month=` ignored (help)
31. ↑ Jian Liang Tan & Sandeep K. Sharma (2018). "Cardiac sarcoidosis presenting with syncope and rapidly progressive atrioventricular block: a case report". European heart journal. Case reports. 2 (4): yty103. doi:10.1093/ehjcr/yty103. PMID 31020179. Unknown parameter `|month=` ignored (help)
32. ↑ Kristen N.. Brown & Rene R.. Diaz (2019). "Restrictive (Infiltrative) Cardiomyopathy". PMID 30725919. Unknown parameter `|month=` ignored (help)
33. ↑ Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link)
34. ↑ Jason Gotlib (2015). "World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management". American journal of hematology. 90 (11): 1077–1089. doi:10.1002/ajh.24196. PMID 26486351. Unknown parameter `|month=` ignored (help)
35. ↑ Jason Gotlib (2015). "World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management". American journal of hematology. 90 (11): 1077–1089. doi:10.1002/ajh.24196. PMID 26486351. Unknown parameter `|month=` ignored (help)
36. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter `|month=` ignored (help)
37. ↑ Jason Gotlib (2015). "World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management". American journal of hematology. 90 (11): 1077–1089. doi:10.1002/ajh.24196. PMID 26486351. Unknown parameter `|month=` ignored (help)
38. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter `|month=` ignored (help)
39. ↑ Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link)
40. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter `|month=` ignored (help)
41. ↑ Paulo Dinis, Rogerio Teixeira, Luis Puga, Carolina Lourenco, Maria Carmo Cachulo & Lino Goncalves (2018). "Eosinophilic Myocarditis: Clinical Case and Literature Review". Arquivos brasileiros de cardiologia. 110 (6): 597–599. doi:10.5935/abc.20180089. PMID 30226920. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link)
42. ↑ Paulo Dinis, Rogerio Teixeira, Luis Puga, Carolina Lourenco, Maria Carmo Cachulo & Lino Goncalves (2018). "Eosinophilic Myocarditis: Clinical Case and Literature Review". Arquivos brasileiros de cardiologia. 110 (6): 597–599. doi:10.5935/abc.20180089. PMID 30226920. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link)
43. ↑ Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link)
44. ↑ Peter Valent, Amy D. Klion, Hans-Peter Horny, Florence Roufosse, Jason Gotlib, Peter F. Weller, Andrzej Hellmann, Georgia Metzgeroth, Kristin M. Leiferman, Michel Arock, Joseph H. Butterfield, Wolfgang R. Sperr, Karl Sotlar, Peter Vandenberghe, Torsten Haferlach, Hans-Uwe Simon, Andreas Reiter & Gerald J. Gleich (2012). "Contemporary consensus proposal on criteria and classification of eosinophilic disorders and related syndromes". The Journal of allergy and clinical immunology. 130 (3): 607–612. doi:10.1016/j.jaci.2012.02.019. PMID 22460074. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link)
45. ↑ Ming Gao, Weihua Zhang, Waiou Zhao, Ling Qin, Fei Pei & Yang Zheng (2018). "Loeffler endocarditis as a rare cause of heart failure with preserved ejection fraction: A case report and review of literature". Medicine. 97 (11): e0079. doi:10.1097/MD.0000000000010079. PMID 29538200. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link)
46. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter `|month=` ignored (help)
47. ↑ Petar M. Seferovic, Marija Polovina, Johann Bauersachs, Michael Arad, Tuvia Ben Gal, Lars H. Lund, Stephan B. Felix, Eloisa Arbustini, Alida L. P. Caforio, Dimitrios Farmakis, Gerasimos S. Filippatos, Elias Gialafos, Vladimir Kanjuh, Gordana Krljanac, Giuseppe Limongelli, Ales Linhart, Alexander R. Lyon, Ruzica Maksimovic, Davor Milicic, Ivan Milinkovic, Michel Noutsias, Ali Oto, Oztekin Oto, Sinisa U. Pavlovic, Massimo F. Piepoli, Arsen D. Ristic, Giuseppe M. C. Rosano, Hubert Seggewiss, Milika Asanin, Jelena P. Seferovic, Frank Ruschitzka, Jelena Celutkiene, Tiny Jaarsma, Christian Mueller, Brenda Moura, Loreena Hill, Maurizio Volterrani, Yuri Lopatin, Marco Metra, Johannes Backs, Wilfried Mullens, Ovidiu Chioncel, Rudolf de Boer, Stefan Anker, Claudio Rapezzi, Andrew J. S. Coats & Carsten Tschope (2019). "Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology". European journal of heart failure. doi:10.1002/ejhf.1461. PMID 30989768. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link)
48. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter `|month=` ignored (help)
49. ↑ Petar M. Seferovic, Marija Polovina, Johann Bauersachs, Michael Arad, Tuvia Ben Gal, Lars H. Lund, Stephan B. Felix, Eloisa Arbustini, Alida L. P. Caforio, Dimitrios Farmakis, Gerasimos S. Filippatos, Elias Gialafos, Vladimir Kanjuh, Gordana Krljanac, Giuseppe Limongelli, Ales Linhart, Alexander R. Lyon, Ruzica Maksimovic, Davor Milicic, Ivan Milinkovic, Michel Noutsias, Ali Oto, Oztekin Oto, Sinisa U. Pavlovic, Massimo F. Piepoli, Arsen D. Ristic, Giuseppe M. C. Rosano, Hubert Seggewiss, Milika Asanin, Jelena P. Seferovic, Frank Ruschitzka, Jelena Celutkiene, Tiny Jaarsma, Christian Mueller, Brenda Moura, Loreena Hill, Maurizio Volterrani, Yuri Lopatin, Marco Metra, Johannes Backs, Wilfried Mullens, Ovidiu Chioncel, Rudolf de Boer, Stefan Anker, Claudio Rapezzi, Andrew J. S. Coats & Carsten Tschope (2019). "Heart failure in cardiomyopathies: a position paper from the Heart Failure Association of the European Society of Cardiology". European journal of heart failure. doi:10.1002/ejhf.1461. PMID 30989768. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link)
50. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter `|month=` ignored (help)
51. ↑ Jason Gotlib (2015). "World Health Organization-defined eosinophilic disorders: 2015 update on diagnosis, risk stratification, and management". American journal of hematology. 90 (11): 1077–1089. doi:10.1002/ajh.24196. PMID 26486351. Unknown parameter `|month=` ignored (help)
52. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter `|month=` ignored (help)
53. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter `|month=` ignored (help)
54. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter `|month=` ignored (help)
55. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter `|month=` ignored (help)
56. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter `|month=` ignored (help)
57. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter `|month=` ignored (help)
58. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter `|month=` ignored (help)
59. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter `|month=` ignored (help)
60. ↑ Sharon Ann Hunt, William T. Abraham, Marshall H. Chin, Arthur M. Feldman, Gary S. Francis, Theodore G. Ganiats, Mariell Jessup, Marvin A. Konstam, Donna M. Mancini, Keith Michl, John A. Oates, Peter S. Rahko, Marc A. Silver, Lynne Warner Stevenson, Clyde W. Yancy, Elliott M. Antman, Sidney C. Jr Smith, Cynthia D. Adams, Jeffrey L. Anderson, David P. Faxon, Valentin Fuster, Jonathan L. Halperin, Loren F. Hiratzka, Alice K. Jacobs, Rick Nishimura, Joseph P. Ornato, Richard L. Page & Barbara Riegel (2005). "ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society". Circulation. 112 (12): e154–e235. doi:10.1161/CIRCULATIONAHA.105.167586. PMID 16160202. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link)
61. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter `|month=` ignored (help)
62. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter `|month=` ignored (help)
63. ↑ Princess U. Ogbogu, Douglas R. Rosing & McDonald K. 3rd Horne (2007). "Cardiovascular manifestations of hypereosinophilic syndromes". Immunology and allergy clinics of North America. 27 (3): 457–475. doi:10.1016/j.iac.2007.07.001. PMID 17868859. Unknown parameter `|month=` ignored (help)
64. ↑ Sharon Ann Hunt, William T. Abraham, Marshall H. Chin, Arthur M. Feldman, Gary S. Francis, Theodore G. Ganiats, Mariell Jessup, Marvin A. Konstam, Donna M. Mancini, Keith Michl, John A. Oates, Peter S. Rahko, Marc A. Silver, Lynne Warner Stevenson, Clyde W. Yancy, Elliott M. Antman, Sidney C. Jr Smith, Cynthia D. Adams, Jeffrey L. Anderson, David P. Faxon, Valentin Fuster, Jonathan L. Halperin, Loren F. Hiratzka, Alice K. Jacobs, Rick Nishimura, Joseph P. Ornato, Richard L. Page & Barbara Riegel (2005). "ACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society". Circulation. 112 (12): e154–e235. doi:10.1161/CIRCULATIONAHA.105.167586. PMID 16160202. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link)
65. ↑ Paulo Dinis, Rogerio Teixeira, Luis Puga, Carolina Lourenco, Maria Carmo Cachulo & Lino Goncalves (2018). "Eosinophilic Myocarditis: Clinical Case and Literature Review". Arquivos brasileiros de cardiologia. 110 (6): 597–599. doi:10.5935/abc.20180089. PMID 30226920. Unknown parameter `|month=` ignored (help)CS1 maint: Multiple names: authors list (link)

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