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
{"title":"Clinical impact of follow-up endomyocardial biopsy in myocarditis during or after immune-suppressive therapy","authors":"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","doi":"10.1002/ehf2.15349","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Aims</h3>\n \n <p>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).</p>\n </section>\n \n <section>\n \n <h3> Methods and results</h3>\n \n <p>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 (<i>n</i> = 12) or suspected myocarditis relapse (<i>n</i> = 7) and to assess IMT response (<i>n</i> = 3). Patients receiving follow-up EMB more likely had abnormal troponin levels (<i>P</i> = 0.048) and a trend towards lower prevalence of anti-heart auto-antibodies positivity at diagnosis (<i>P</i> = 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.</p>\n </section>\n \n <section>\n \n <h3> Conclusions</h3>\n \n <p>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.</p>\n </section>\n </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 5","pages":"3707-3718"},"PeriodicalIF":3.7000,"publicationDate":"2025-06-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ehf2.15349","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"ESC Heart Failure","FirstCategoryId":"3","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/ehf2.15349","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
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.
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.