The value of left ventricular and left atrial strains in eosinophilic myocarditis and hypereosinophilic syndrome

Q: What was the study aim regarding strain imaging in HES?

To evaluate the value of strain imaging in hypereosinophilic syndrome (HES), including assessment of cardiac involvement with eosinophilic myocarditis (EM).

Q: Which findings related LVGLS to clinical outcomes?

Patients with worse LVGLS had a significantly higher incidence of the primary endpoint, which combined stroke at diagnosis and major adverse cardiovascular events during follow-up.

Sep 30, 2026

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Evaluation of strain imaging utility in hypereosinophilic syndrome (HES) and its cardiac complication, eosinophilic myocarditis (EM), used a cross-sectional cohort of adults with HES. Left ventricular global longitudinal strain (LVGLS) and left atrial (LA) strain, together with right ventricular (RV) free wall strain, were measured. Among 34 confirmed HES patients, EM showed significantly worse LVGLS and LA reservoir and contraction strains, with LVGLS impairment linked to increased primary endpoint risk, including stroke and major adverse cardiovascular events.

LanguageEnglish

CategoryHealthcare

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Pages12

Reading Time30 min

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Introduction

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The value of left ventricular and left atrial strains in eosinophilic myocarditis and hypereosinophilic syndrome Yuichiro Okushi1, Matthew Reeder2, Mohammad Al Zein1, Saberio Lo Presti Vega1, Richard A. Grimm1, Brian P. Griffin1, Bo Xu1^ 1Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA; 2Department of Medicine, Cleveland Clinic, Cleveland, OH, USA Contributions: (I) Conception and design: B Xu; (II) Administrative support: B Xu; (III) Provision of study materials or patients: B Xu; (IV) Collection and assembly of data: Y Okushi, M Reeder, M Al Zein, S Lo Presti Vega; (V) Data analysis and interpretation: Y Okushi; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Bo Xu, MD, FACC, FASE, FRACP. Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Desk J1-5, 9500 Euclid Ave., Cleveland, OH 44195, [USA. Email: xub@ccf.org](USA. Email: xub@ccf.org). Background: Hypereosinophilic syndrome (HES) is a rare disease characterized by persistent eosinophilia associated with organ damage, and may be complicated by eosinophilic myocarditis (EM) . However, the utility of strain imaging in these conditions remains unclear. We aimed to evaluate the value of strain imaging in HES. Methods: We performed a cross-sectional study of all patients aged >18 years diagnosed with HES at Cleveland Clinic between September 1986 and January 2023. Left ventricular global longitudinal strain (LVGLS), left atrial (LA) strain, and right ventricular (RV) free wall strain were measured. The primary endpoint was a composite of stroke at diagnosis and major adverse cardiovascular events during the follow up period. Outcomes were compared using chi-square tests. Results: Of 1,664 patients with eosinophilia, 34 patients with confirmed HES were included in the final cohort. The mean age was 57±16 years, and 58.8% were female. The median follow-up duration was 85 months. Among them, ten patients (29.4%) were diagnosed with EM and twelve patients (35.3%) developed the primary endpoint. EM patients had significantly worse LVGLS (−9.7% vs. −15.5%, P<0.001), LA reservoir strain (21 .0% vs. 32. 1%, P=0 .02) and LA contraction strain (−9 . 7% vs. −19 .2%, P<0 .001) compared to non-EM patients, but there was no significant difference in RV free wall strain (−17.5% vs. −23.4%, P=0.08) . All EM patients and half of non-EM patients had LVGLS worse than −16% . Patients with worse LVGLS had significantly higher incidence of primary endpoint compared to patients with normal LVGLS (47.6% vs. 9.1%, P=0.03) . Conclusions: LVGLS is frequently impaired in patients with EM, and is associated with increased risk of stroke and major cardiovascular events. These findings suggest its potential as a marker of cardiac involvement and prognosis in HES. Keywords: Hypereosinophilic syndrome (HES); eosinophilic myocarditis (EM); echocardiography; left ventricular global longitudinal strain (LVGLS); stroke Submitted May 29, 2025. Accepted for publication Oct 28, 2025. Published online Dec 08, 2025. doi: 10.21037/cdt-2025-287 View this article at: [https://dx.doi.org/10.21037/cdt-2025-287](https://dx.doi.org/10.21037/cdt-2025-287) ^ ORCID: 0000-0002-2985-7468. © AME Publishing Company. Cardiovasc Diagn Ther 2025;15(6):1122-1133 | [https://dx.doi.org/10.21037/cdt-2025-287](https://dx.doi.org/10.21037/cdt-2025-287) Cardiovascular Diagnosis and Therapy, Vol 15, No 6 December 2025 1123 Introduction Hypereosinophilic syndrome (HES) is a heterogeneous group of rare disorders distinguished by sustained peripheral or tissue hypereosinophilia with concurrent evidence of eosinophil-mediated organ damage (1,2) .

FAQs

What was the study aim regarding strain imaging in HES?

To evaluate the value of strain imaging in hypereosinophilic syndrome (HES), including assessment of cardiac involvement with eosinophilic myocarditis (EM).

How were left ventricular and left atrial strain measures used in the results?

Left ventricular global longitudinal strain (LVGLS) and left atrial (LA) strain were compared between HES patients with EM and those without EM, showing significantly worse LVGLS and LA strain in EM.

Which findings related LVGLS to clinical outcomes?

Patients with worse LVGLS had a significantly higher incidence of the primary endpoint, which combined stroke at diagnosis and major adverse cardiovascular events during follow-up.

Sep 30, 2026

Upload by Margaret