Comparative Evaluation of Left and Right Ventricular Endomyocardial Biopsy

Abstract

Background-Endomyocardial biopsy (EMB) represents the gold standard for diagnosing myocarditis and nonischemic cardiomyopathies. This study focuses on the risk of complications and the respective diagnostic performance of left ventricular (LV), right ventricular (RV), or biventricular EMB in patients with suspected myocarditis and/or cardiomyopathy of unknown origin. Methods and Results-In this 2-center study, 755 patients with clinically suspected myocarditis (nϭ481) and/or cardiomyopathy of nonischemic origin including those with infiltrative or connective tissue disease (nϭ274) underwent either selective LV-EMB (nϭ265; 35.1%), selective RV-EMB (nϭ133; 17.6%), or biventricular EMB (nϭ357; 47.3%) after coronary angiography and exclusion of significant coronary artery disease. Cardiovascular magnetic resonance, including late gadolinium enhancement, imaging was performed in 540 patients (71.5%). The major complication rate for LV-EMB was 0.64% and for RV-EMB, 0.82%. Considering postprocedural pericardial effusion that occurred after biventricular EMB, the minor complication rate for LV-EMB varied between 0.64% to 2.89% and for RV-EMB, between 2.24% and 5.10%. Diagnostic EMB results were achieved significantly more often in those patients who underwent biventricular EMBs (79.3%) compared to those who underwent either selective LV-EMB or selective RV-EMB (67.3%; PϽ0.001). In patients with biventricular EMB, myocarditis was diagnosed in LV-EMB samples in 18.7% and in RV-EMB samples in 7.9% (Pϭ0.002) , and it was diagnosed in both ventricles in 73.4%. There were no differences in the number of positive LV-EMB, RV-EMB, or LV-and RV-EMB findings when related to the site of cardiovascular magnetic resonance-based late gadolinium enhancement. Conclusions-Both

Giant-Cell Myocarditis Complicated by Heparin-induced Thrombocytopenia

“…In particular, performing an endomyocardial biopsy in the acute phase of myocarditis may be associated with higher risks, since the procedure is sometimes complicated by ventricular perforation of edematous myocardium, fatal arrhythmia and other fatal incidents. In contrast, the most recent study showed that the major complication rate for left ventricular endomyocardial biopsies is 0.64% and that for right ventricular endomyocardial biopsies is 0.82%, thus indicating a lower risk compared with previous reports (14). The recently published guidelines of the American Heart Association, the American College of Cardiology and the European Society of Cardiology state that new-onset heart failure of two weeks duration associated with a normal-sized or dilated left ventricle and hemodynamic compromise is a class I indication for a left ventricular endomyocardial biopsy (15).…”

Clinical and Pathological Impact of Tissue Fibrosis on Lethal Arrhythmic Events in Hypertrophic Cardiomyopathy Patients With Impaired Systolic Function

“…16, 17 A key mechanism involved in adverse outcomes in HCM is believed to be myocardial fibrosis, which is a pathological hallmark of the condition, 18 and can be identified by biopsy. 19, 20 Recent studies of HCM patients suggest that the extent of fibrosis as measured by CMR correlates with histologically proven myocardial scarring 11 and is associated with worse prognosis, 10 including arrhythmic events. 6,9,21 However, in this study, fibrotic change (LGE %LV mass) by CMR-LGE did not reach statistical significance for the prediction of lethal arrhythmic events (HR=1.04, 95% CI: 1.00-1.10, P=0.06) ( Table 3).…”

Variants of Toll-like Receptor 4 Predict Cardiac Recovery in Patients with Dilated Cardiomyopathy

“…In brief, to identify myocarditis, myocardial tissues were stained with hematoxylin and eosin, Masson's trichrome, and Giemsa following examination by light microscopy. Histological analyses were performed according to the Dallas criteria (22,23). Immunohistological analyses were used to investigate cardiac inflammation by treating the paraffin-embedded tissue sections with an avidin-biotin-immunoperoxidase method according to the manufacturer's protocol (Vectastain Elite ABC kit, Vectastain) (8).…”

“…In the light of cardiovascular diseases, human genetic studies exist only for patients with peripheral, central, or coronary atherosclerosis. These diseases occur with much higher incidence in comparison with DCM, which could explain the high number of included patients (23). Nevertheless, to the best of our knowledge, there is no larger well defined patient cohort of DCM that has investigated gene polymorphisms of innate immune proteins.…”