Henriikka Mälkönen, Jukka Lehtonen, Pauli Pöyhönen, Valtteri Uusitalo, Mikko I. Mäyränpää, Markku Kupari
{"title":"Endomyocardial biopsy in the diagnosis of cardiac sarcoidosis","authors":"Henriikka Mälkönen, Jukka Lehtonen, Pauli Pöyhönen, Valtteri Uusitalo, Mikko I. Mäyränpää, Markku Kupari","doi":"10.1002/ejhf.3545","DOIUrl":null,"url":null,"abstract":"AimsWe set out to assess the utility of endomyocardial biopsy (EMB) in cardiac sarcoidosis (CS). Historically, EMB sensitivity in CS is only ≤25%, but comprehensive analyses of its current diagnostic performance are not available.Methods and resultsThe data of 260 consecutive patients with <jats:styled-content style=\"fixed-case\">CS</jats:styled-content> (mean age 49 years, 60% female) meeting the Heart Rhythm Society diagnostic criteria were analysed retrospectively. Overall, 216 patients (83%) had undergone <jats:styled-content style=\"fixed-case\">EMB</jats:styled-content>, 47 with repeat procedures. <jats:styled-content style=\"fixed-case\">EMB</jats:styled-content> overall sensitivity was 38%, rising to 49% after repeat biopsies. On logistic regression analysis, positive <jats:styled-content style=\"fixed-case\">EMB</jats:styled-content> was predicted independently by presentation with ventricular tachyarrhythmia with an odds ratio (<jats:styled-content style=\"fixed-case\">OR</jats:styled-content>) of 3.8 (95% confidence interval [CI] 1.2–12.0, <jats:italic>p</jats:italic> = 0.021), left ventricular ejection fraction ≤45% (<jats:styled-content style=\"fixed-case\">OR</jats:styled-content> 3.7, 95% CI 1.5–9.1, <jats:italic>p</jats:italic> = 0.004), elevation of cardiac troponins (<jats:styled-content style=\"fixed-case\">OR</jats:styled-content> 2.7, 95% CI 1.1–6.4, <jats:italic>p</jats:italic> = 0.024), and presence of late gadolinium enhancement in left ventricular mid‐apical septal segments on magnetic resonance imaging (<jats:styled-content style=\"fixed-case\">OR</jats:styled-content> 4.1, 95% CI 1.2–13.8, <jats:italic>p</jats:italic> = 0.024). <jats:styled-content style=\"fixed-case\">EMB</jats:styled-content> sensitivity, counting in repeats, was 16% in patients (<jats:italic>n</jats:italic> = 37) without any independent predictor versus 38%, 60%, 79%, and 88% in those with 1 (<jats:italic>n</jats:italic> = 76), 2 (<jats:italic>n</jats:italic> = 62), 3 (<jats:italic>n</jats:italic> = 33), and 4/4 (<jats:italic>n</jats:italic> = 8) predictors, respectively. The rate of serious complications was 0.7% without mortality or permanent harm. Positive <jats:styled-content style=\"fixed-case\">EMB</jats:styled-content> was not an independent predictor of prognosis.ConclusionThe sensitivity of <jats:styled-content style=\"fixed-case\">EMB</jats:styled-content> in <jats:styled-content style=\"fixed-case\">CS</jats:styled-content> depends on the extent, activity, and location of myocardial involvement, being the higher the more severe <jats:styled-content style=\"fixed-case\">CS</jats:styled-content> is. Its use should rely on weighing the pre‐test likelihood and individual value of positive biopsy against the procedural risks.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"27 1","pages":""},"PeriodicalIF":16.9000,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Journal of Heart Failure","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/ejhf.3545","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
AimsWe set out to assess the utility of endomyocardial biopsy (EMB) in cardiac sarcoidosis (CS). Historically, EMB sensitivity in CS is only ≤25%, but comprehensive analyses of its current diagnostic performance are not available.Methods and resultsThe data of 260 consecutive patients with CS (mean age 49 years, 60% female) meeting the Heart Rhythm Society diagnostic criteria were analysed retrospectively. Overall, 216 patients (83%) had undergone EMB, 47 with repeat procedures. EMB overall sensitivity was 38%, rising to 49% after repeat biopsies. On logistic regression analysis, positive EMB was predicted independently by presentation with ventricular tachyarrhythmia with an odds ratio (OR) of 3.8 (95% confidence interval [CI] 1.2–12.0, p = 0.021), left ventricular ejection fraction ≤45% (OR 3.7, 95% CI 1.5–9.1, p = 0.004), elevation of cardiac troponins (OR 2.7, 95% CI 1.1–6.4, p = 0.024), and presence of late gadolinium enhancement in left ventricular mid‐apical septal segments on magnetic resonance imaging (OR 4.1, 95% CI 1.2–13.8, p = 0.024). EMB sensitivity, counting in repeats, was 16% in patients (n = 37) without any independent predictor versus 38%, 60%, 79%, and 88% in those with 1 (n = 76), 2 (n = 62), 3 (n = 33), and 4/4 (n = 8) predictors, respectively. The rate of serious complications was 0.7% without mortality or permanent harm. Positive EMB was not an independent predictor of prognosis.ConclusionThe sensitivity of EMB in CS depends on the extent, activity, and location of myocardial involvement, being the higher the more severe CS is. Its use should rely on weighing the pre‐test likelihood and individual value of positive biopsy against the procedural risks.
期刊介绍:
European Journal of Heart Failure is an international journal dedicated to advancing knowledge in the field of heart failure management. The journal publishes reviews and editorials aimed at improving understanding, prevention, investigation, and treatment of heart failure. It covers various disciplines such as molecular and cellular biology, pathology, physiology, electrophysiology, pharmacology, clinical sciences, social sciences, and population sciences. The journal welcomes submissions of manuscripts on basic, clinical, and population sciences, as well as original contributions on nursing, care of the elderly, primary care, health economics, and other related specialist fields. It is published monthly and has a readership that includes cardiologists, emergency room physicians, intensivists, internists, general physicians, cardiac nurses, diabetologists, epidemiologists, basic scientists focusing on cardiovascular research, and those working in rehabilitation. The journal is abstracted and indexed in various databases such as Academic Search, Embase, MEDLINE/PubMed, and Science Citation Index.