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From the wiki

The Purple Heart increases the chance of Challenge Rooms to be Boss Challenge Rooms and causes more enemy champions to spawn.

This sounds like a bad thing.

The only positive thing I can think of is that with more champions you get more item drops.

Are there any other upsides I am missing?

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The Purple Heart is a double edged sword while it does make the run more challenging it provides a better chance at getting items and loot. It is as you mentioned that you do get more item drops from having the increased champion spawns.

The increased chance of a boss challenge room is also a net positive if you are lucky as well. According to the Binding of Isaac wiki the default challenge rooms can contain the following loot:

  • 1 or 2 Chests / Golden Chests / Red Chests
  • 3 Red Chests
  • 1 Chest + 1 Golden Chest + 1 Red Chest
  • A random item from Treasure Room pool.

The boss challenge room adds the possibility of receiving a item out of the boss item pool which may be very helpful if you can handle the boss challenge room. So overall if you are able to handle the increased challenge the purple heart is worth the risk of holding it.

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