Indications and diagnostic yield of endomyocardial biopsies for unexplained cardiomyopathy, a single center experience

Ramaekers, Jobbe; Janssens, Joyce; Waumans, Lise; Stessens, Linde; Dupont, Matthias; Mullens, Wilfried; Martens, Pieter

doi:10.1080/00015385.2018.1561597

Cited by 7 publications

(5 citation statements)

References 17 publications

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“…Bennett et al reported on 109 patients with new-onset heart failure in which they were able to make a definitive diagnosis on EMB in 39% which consisted largely of myocarditis patients. 9 Although Ramaekers et al 28 established a final diagnosis in 58% of their population, it should be noted that this study only consisted of 9 patients with new-onset heart failure. The differences between the results of these studies and our VA-ECMO population could be explained by several factors.…”

Section: Discussionmentioning

confidence: 90%

Safety of Endomyocardial Biopsy in New-Onset Acute Heart Failure Requiring Veno-Arterial Extracorporeal Membrane Oxygenation

Boon

Dekker

Meuwese

et al. 2021

Circ: Heart Failure

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Background: Endomyocardial biopsy (EMB) has an important role in determining the pathogenesis of new-onset acute heart failure (new-AHF) when noninvasive testing is impossible. However, data on safety and histopathologic outcomes in patients requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is lacking. Methods: A retrospective, multicenter cohort of patients undergoing EMB while requiring VA-ECMO for new-AHF between 1990 and 2020 was compared with a cohort of nontransplant related biopsies not requiring VA-ECMO. Primary end point of the study was to determine the safety of EMB. Additionally, we describe the underlying pathogenesis causing new-AHF based on histopathologic examination of the samples obtained. Results: A total of 23 patients underwent EMB while requiring VA-ECMO (10.0%), 125 (54.3%) during an unplanned admission, and 82 (35.7%) in elective setting. Major complications occurred in 8.3% of all procedures with a significantly higher rate in patients requiring VA-ECMO (26.1% versus 8.0% versus 3.7%, P =0.003) predominately due to the occurrence of sustained ventricular tachycardia or need of resuscitation (13.0% versus 3.2% versus 1.2%, P =0.02). EMB led to a histopathologic diagnosis in 78.3% of the patients requiring VA-ECMO which consisted primarily of patients with myocarditis (73.9%). Conclusions: EMB in patients requiring VA-ECMO can be performed albeit with a substantial risk of major complications. The risk of the procedure was offset by a histopathologic diagnosis in 78.3% of the patients, which for the majority consisted of patients with myocarditis. The important therapeutic and prognostic implications of establishing an underlying pathogenesis causing new-AHF in this population warrant further refinement to improve procedural safety.

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Section: Discussionmentioning

confidence: 90%

Safety of Endomyocardial Biopsy in New-Onset Acute Heart Failure Requiring Veno-Arterial Extracorporeal Membrane Oxygenation

Boon

Dekker

Meuwese

et al. 2021

Circ: Heart Failure

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“…new acquisitions on the subject of prognostic elements come more recently from echocardiographic studies that have used the speckle tracking method [15]. Cardiac-MRI has several properties in the evaluation of suspected amyloid heart disease: High spatial resolution that permit a reproducible measurement of cardiac chamber volumes and mass, as subjecting patients to also experimental therapies [25,26].…”

Section: Discussionmentioning

confidence: 99%

Second Level Management of a Complex Case with Suspected Cardiac Amyloidosis: A Challenge for the Clinician

Massimo¹

2019

Ann Heart

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We report the clinical case report of a 67-year-old patient with diagnoses of hypertension, ischemic heart disease and a previous history of Acute Myocardial Infarction (AMI) and nonspecific signs and symptoms (general illness, weight loss, hyporexia, fever, impressive edema at the feet, systemic arterial hypotension). So, we performed a series of laboratory, radiological and instrumental examinations, but the clinical picture remained difficult to interpret. The echocardiographic evaluation led us to a suspicion of infiltrative heart disease, and the magnetic resonance, while confirming the interesting data observed at the ultrasound exam. Therefore, we decided to perform a biopsy, which appeared positive for our suspicion. So, we thought we did not waste any more precious time and, after stabilizing the patient, we sent our patient to a specialized diagnostic center for diagnostic confirmation and the beginning of targeted therapies. Clinical, laboratory and instrumental implications of this differential diagnosis are discussed.

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“…3,4 The gold standard for diagnosing myocarditis is endomyocardial biopsy 5 but it is invasive and its diagnostic yield is low at 25-58%. 5,6 On the other hand, peripartum cardiomyopathy is a diagnosis of exclusion. It is idiopathic cardiomyopathy presenting with heart failure secondary to LV systolic dysfunction toward the end of pregnancy or in months following delivery where no other cause of heart failure is found.…”

Section: Discussionmentioning

confidence: 99%

Peripartum Cardiomyopathy and Systemic Lupus Erythematosus Carditis, a diagnostic dilemma

Poudel¹,

P²,

Lamsal³

et al. 2020

Nepalese Heart J.

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A young woman at 8 months postpartum presented with dyspnoea, orthopnoea and swelling of lower limbs in which physical examination, chest radiography and echocardiogram were suggestive of acute congestive heart failure with left ventricle dilatation and dysfunction. A suspicion of peripartum cardiomyopathy was made and treated with conventional drug therapy but the patient continued to develop multiple episodes of heart failure. Over time she developed fever and polyarthritis following which autoantibodies, complement level and 24-hour urinary protein were done which helped us to make the diagnosis of Systemic Lupus Erythematosus (SLE) nephritis. The patient was started on high dose corticosteroids. However, after a week, patient developed cardiogenic shock following which intravenous pulse Cyclophosphamide was started and the patient improved clinically and biochemically.

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Indications and diagnostic yield of endomyocardial biopsies for unexplained cardiomyopathy, a single center experience

Cited by 7 publications

References 17 publications

Safety of Endomyocardial Biopsy in New-Onset Acute Heart Failure Requiring Veno-Arterial Extracorporeal Membrane Oxygenation

Safety of Endomyocardial Biopsy in New-Onset Acute Heart Failure Requiring Veno-Arterial Extracorporeal Membrane Oxygenation

Second Level Management of a Complex Case with Suspected Cardiac Amyloidosis: A Challenge for the Clinician

Peripartum Cardiomyopathy and Systemic Lupus Erythematosus Carditis, a diagnostic dilemma

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