{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T17:42:54Z","timestamp":1791049374890,"version":"4.1.0"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circulation"],"published-print":{"date-parts":[[2026,3,3]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>No large registries of patients with acute eosinophilic myocarditis (EM) are available. However, EM is perceived as a cardiac disease with high mortality, affecting mainly young and middle-aged adults according to small series and case reports. Awareness of the clinical presentation, associated systemic conditions, treatments, and outcomes of this uncommon condition is an unmet need.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>In this international, multicenter, retrospective cohort study, 53 centers screened 193 patients with histologically proven acute EM between 1992 and 2023. After the exclusion of patients with insufficient data (n=10), symptoms lasting &gt;30 days (n=19), or histological diagnosis not confirmed after review (n=8), 156 patients were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Median age at presentation was 48 years (first to third quartile, 34\u201359 years) with male predominance (67.3%), and only 2 were pediatric cases (\u226416 years of age; 1.3%). The main signs and symptoms at presentation were dyspnea (75.6%), fever (61.3%), and chest pain (53.2%). Unexpectedly, peripheral eosinophilia was reported in only 57.4% of cases, with a median cell count of 630 eosinophils\/\u03bcL. The median left ventricular ejection fraction at presentation was 32% (first to third quartile, 25%\u201348%). The disorders most frequently associated with EM were eosinophilic granulomatosis with polyangiitis (22.4% of cases) and hypersensitivity forms (14.1%). Idiopathic\/undefined forms accounted for 44.9% of cases, and miscellaneous causes accounted for 18.6%. In-hospital death or need for heart transplantation (HTx) occurred in 23 patients (14.7%; 22 deaths and 1 HTx), despite 43.6% being treated with temporary mechanical circulatory support and 92.9% being treated with immunosuppressive agents. Estimated rates of death or HTx at 1 and 3 years were 19.0% and 23.8%. Increased age, decreased left ventricular ejection fraction on admission, and no immunosuppressive therapy during hospitalization were independent predictors of death or HTx. A nonsignificant higher occurrence of deaths or HTx was observed in the hypersensitivity form (46.1%) compared with the eosinophilic granulomatosis with polyangiitis\u2013associated form (13.1%) at 3 years (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.15).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Acute EM can often present without peripheral eosinophilia, and rates of in-hospital and midterm mortality or HTx are high. Endomyocardial biopsy is required to reach the final diagnosis of EM because relying on peripheral eosinophilia can lead to missing diagnosis. In-hospital immunosuppression is associated with HTx-free survival, although tailored immunosuppressive therapies are needed to improve outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>REGISTRATION:<\/jats:title>\n                    <jats:p>\n                      URL:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n                      ; Unique identifier: NCT06447935.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circulationaha.125.074797","type":"journal-article","created":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T10:01:45Z","timestamp":1770372105000},"page":"634-652","update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Natural History of Patients With Histologically Proven Acute Eosinophilic Myocarditis"],"prefix":"10.1161","volume":"153","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1676-5257","authenticated-orcid":true,"given":"Enrico","family":"Ammirati","sequence":"first","affiliation":[{"name":"De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy (E.A., M.P., P.G., A.G.)."},{"name":"School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy (E.A., P.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1700-7340","authenticated-orcid":true,"given":"Matteo","family":"Palazzini","sequence":"additional","affiliation":[{"name":"De Gasperis Cardio Center, Niguarda Hospital, Milan, Italy (E.A., M.P., P.G., A.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7637-6061","authenticated-orcid":true,"given":"Jukka","family":"Lehtonen","sequence":"additional","affiliation":[{"name":"Heart and Lung Center, Helsinki University Hospital, Finland (J.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7388-5012","authenticated-orcid":true,"given":"Luciano","family":"Potena","sequence":"additional","affiliation":[{"name":"Heart Failure and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy (L.P., A. Fo\u00e0)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0877-9640","authenticated-orcid":true,"given":"Mikko I.","family":"M\u00e4yr\u00e4np\u00e4\u00e4","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Helsinki, and Diagnostic Center, Helsinki University Hospital, Finland (M.I.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Johanna","family":"R\u00e5gback","sequence":"additional","affiliation":[{"name":"Internal Medicine, Helsinki University Hospital and University of Helsinki, Finland (J.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1216-4478","authenticated-orcid":true,"given":"Alberto","family":"Fo\u00e0","sequence":"additional","affiliation":[{"name":"Heart Failure and Transplant Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Italy (L.P., A. Fo\u00e0)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6911-7480","authenticated-orcid":true,"given":"Aitor","family":"Uribarri","sequence":"additional","affiliation":[{"name":"Cardiology Department, Hospital Universitari Vall d\u2019Hebron, Barcelona, Spain (A.U., M.V.-B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0169-998X","authenticated-orcid":true,"given":"Holger","family":"Thiele","sequence":"additional","affiliation":[{"name":"Heart Center Leipzig at Leipzig University and Leipzig Heart Science, Germany (H.T., A. Freund)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9823-5021","authenticated-orcid":true,"given":"Mar\u00eda","family":"Vidal-Burdeus","sequence":"additional","affiliation":[{"name":"Cardiology Department, Hospital Universitari Vall d\u2019Hebron, Barcelona, Spain (A.U., M.V.-B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4999-6238","authenticated-orcid":true,"given":"Anne","family":"Freund","sequence":"additional","affiliation":[{"name":"Heart Center Leipzig at Leipzig University and Leipzig Heart Science, Germany (H.T., A. 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