Clinical impact of follow-up endomyocardial biopsy in myocarditis during or after immune-suppressive therapy

IF 3.7 2区 医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Anna Baritussio, Andrea Silvio Giordani, Stefania Rizzo, Cristina Vicenzetto, Monica De Gaspari, Elisa Carturan, Giuseppe Toscano, Federico Scognamiglio, Giuseppe Tarantini, Sabino Iliceto, Cristina Basso, Renzo Marcolongo, Alida Linda Patrizia Caforio
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引用次数: 0

Abstract

Aims

While the diagnostic role of endomyocardial biopsy (EMB) in myocarditis is unquestioned, little is known about its indications and clinical value during long-term follow-up. We aim to report our experience on the clinical relevance of repeating EMB in a cohort of biopsy-proven myocarditis patients treated with immune-suppressive therapy (IMT).

Methods and results

We retrospectively included 92 patients with virus-negative EMB-proven myocarditis treated with IMT, of whom 22 [73% male, 37 years, interquartile range (IQR) 33–48] received at least one, uneventful, follow-up EMB, 3.5 years (IQR 2.5–5.3) after the first one. Follow-up EMB was performed because of clinical worsening (n = 12) or suspected myocarditis relapse (n = 7) and to assess IMT response (n = 3). Patients receiving follow-up EMB more likely had abnormal troponin levels (P = 0.048) and a trend towards lower prevalence of anti-heart auto-antibodies positivity at diagnosis (P = 0.05) and showed worse imaging findings at follow-up. Active or borderline myocarditis on follow-up EMB was found in 12 patients, leading to a change in IMT regimen in 10 (83%); among patients with evidence of healed myocarditis, 2 had a change in IMT regimen, 2 underwent heart transplant evaluation check list, 2 had mitral valve treatment, 1 received ventricular tachycardia ablation and 1 primary prevention implantable cardioverter-defibrillator implantation.

Conclusions

One-fourth of EMB-proven myocarditis patients had a clinical indication to repeat EMB at least once during long-term follow-up. Follow-up EMB was safe in all cases; it showed active or borderline myocarditis in 55% of patients and lead to a change in management in the majority of patients.

Abstract Image

免疫抑制治疗期间或之后心肌炎患者随访心内膜活检的临床影响。
目的:虽然心肌炎内膜活检(EMB)的诊断作用毋庸置疑,但在长期随访中对其适应症和临床价值知之甚少。我们的目的是报告我们在活检证实的接受免疫抑制治疗(IMT)的心肌炎患者中重复EMB的临床相关性的经验。方法和结果:我们回顾性纳入92例经IMT治疗的病毒阴性EMB证实的心肌炎患者,其中22例(73%男性,37岁,四分位数间距(IQR) 33-48)在第一次EMB治疗后至少接受了一次无事件的随访EMB治疗,随访时间为3.5年(IQR 2.5-5.3)。因临床恶化(n = 12)或疑似心肌炎复发(n = 7)进行EMB随访,以评估IMT反应(n = 3)。接受EMB随访的患者更有可能出现肌钙蛋白水平异常(P = 0.048),诊断时抗心脏自身抗体阳性率呈下降趋势(P = 0.05),随访时影像学表现更差。12例患者在EMB随访中发现活动性或边缘性心肌炎,其中10例(83%)改变了IMT治疗方案;有心肌炎愈合证据的患者中,2例改变了IMT方案,2例接受了心脏移植评估检查表,2例接受了二尖瓣治疗,1例接受了室性心动过速消融,1例接受了一级预防植入式心律转复除颤器植入。结论:四分之一经EMB证实的心肌炎患者在长期随访期间至少有一次重复EMB的临床指征。所有病例随访EMB均安全;55%的患者表现为活动性或边缘性心肌炎,并导致大多数患者改变治疗方法。
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来源期刊
ESC Heart Failure
ESC Heart Failure Medicine-Cardiology and Cardiovascular Medicine
CiteScore
7.00
自引率
7.90%
发文量
461
审稿时长
12 weeks
期刊介绍: ESC Heart Failure is the open access journal of the Heart Failure Association of the European Society of Cardiology dedicated to the advancement of knowledge in the field of heart failure. The journal aims to improve the understanding, prevention, investigation and treatment of heart failure. Molecular and cellular biology, pathology, physiology, electrophysiology, pharmacology, as well as the clinical, social and population sciences all form part of the discipline that is heart failure. Accordingly, submission of manuscripts on basic, translational, clinical and population sciences is invited. Original contributions on nursing, care of the elderly, primary care, health economics and other specialist fields related to heart failure are also welcome, as are case reports that highlight interesting aspects of heart failure care and treatment.
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