CONGRESS ABSTRACT

Background: Eosinophilic granulomatosis with polyangiitis (EGPA) is a systemic vasculitis characterized by marked eosinophilia and potential cardiovascular involvement. The impact of eosinophil burden on early pulmonary vascular and right ventricular–pulmonary artery (RV–PA) function remains poorly defined. Objectives: To assess the association between peripheral eosinophil count (PEC) at diagnosis and subclinical echocardiographic markers of pulmonary vascular dysfunction, and to evaluate the longitudinal effects of anti–IL-5 therapy. Methods: Twenty-seven patients with EGPA underwent comprehensive echocardiographic evaluation, including pulmonary artery systolic pressure (PAPs), tricuspid annular plane systolic excursion (TAPSE), TAPSE/PAPs ratio, and tricuspid regurgitation velocity (TRV). Associations between PEC at diagnosis and echocardiographic parameters were analyzed. Patients treated with anti–IL-5 agents (mepolizumab or benralizumab) were evaluated at diagnosis, at treatment initiation (T0), and after 24 months (T24). Multivariable regression and ROC analyses were performed. Results: At T0, 33% of patients showed elevated PAPs (>25 mmHg) in the absence of clinical pulmonary hypertension. Higher PEC was independently associated with increased PAPs (p=0.04) and reduced TAPSE/PAPs ratio (p=0.03). PAPs and TRV significantly worsened between diagnosis and T0, followed by significant improvement at T24 after anti–IL-5 therapy (PAPs Δ −7.89 mmHg, p=0.001; TRV Δ −0.35 m/s, p<0.001; TAPSE/PAPs Δ +0.41, p=0.005). A PEC threshold of 3,465 cells/μL predicted elevated PAPs (AUC 0.696, 95% CI 0.47–0.92; sensitivity 91.7%). Conclusions: In EGPA, higher eosinophil burden is associated with early pulmonary vascular dysfunction and RV–PA uncoupling, which appear partially reversible with anti–IL-5 therapy. These findings support early cardiovascular screening in eosinophil-rich EGPA phenotypes.