Xuejing Duan, Yang Sun, Li Li, Lingmin Wu, Zhongkai Liao, Yuhui Zhang, Litian Yu, Yan Yao, Lei Song, Hongyue Wang
{"title":"中国队列心内膜活检最新适应症的诊断率及其临床预测因子","authors":"Xuejing Duan, Yang Sun, Li Li, Lingmin Wu, Zhongkai Liao, Yuhui Zhang, Litian Yu, Yan Yao, Lei Song, Hongyue Wang","doi":"10.1159/000545748","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>The challenging and restrictive settings have been proposed in the updated indications for endomyocardial biopsy (EMB), but no data shows its performance. This study aimed to evaluate the diagnostic yield and find its clinical predictors.</p><p><strong>Methods: </strong>All EMB performed between 2018 and 2022 were reviewed. Their clinical scenario and diagnostic yield were categorized retrospectively. Repeated and inadequate biopsies were excluded. Multivariate analysis was used to find the predictors.</p><p><strong>Results: </strong>A total of 681 cases were collected (median age 44.0 years, 65.5% male) and 230 cases (33.8%) yielded specific diagnosis. The higher yield (52.8%) was found in clinically suspected myocarditis while no significant difference between cases with and without acute unstable hemodynamics (66.7% vs 47.1%; P=0.130). There was a much higher yield in unexplained restrictive or hypertrophic cardiomyopathy (RCM/HCM) with suspected infiltrative or storage disorder compared to those without (86.2% vs 10.3%; P<0.001). Dilated cardiomyopathy showed a lower yield, with or without recent-onset moderate-to-severe cardiac dysfunction (13.6% vs 16.3%; P=1.000). The same was true for unexplained atrioventricular block and ventricular arrhythmias (AVB/VA), with or without obvious structural abnormalities (8.2% vs 10.3%; P=0.675). On multivariate analysis, diffuse late gadolinium enhancement (odds ratio [OR] 4.14, 95% confidence interval [CI] 1.86-9.25; P=0.001), time course of disease ≤12 months (OR 3.31, 95% CI 1.75-5.57; P<0.001), elevated(≥1250 pg/ml)NT-proBNP (OR 2.91, 95% CI 1.67-5.06; P<0.001), and elevated (>0.068 ng/ml) hs-cTnI (OR 2.37, 95% CI 1.33-4.22; P=0.004) were independently associated with diagnostic yield.</p><p><strong>Conclusion: </strong>Our results partially support the restrictive settings. EMB can achieve higher yield for unexplained RCM/HCM with suspected infiltrative or storage disorder, as well as strictly defined clinically suspected myocarditis, even in hemodynamically stable patients. However, the restrictive settings of unexplained AVB/VA and dilated cardiomyopathy did not show a clear advantage in diagnostic yield. The predictors this study found may help clinicians in selecting adequate candidates.</p>","PeriodicalId":9391,"journal":{"name":"Cardiology","volume":" ","pages":"1-16"},"PeriodicalIF":1.9000,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105824/pdf/","citationCount":"0","resultStr":"{\"title\":\"Diagnostic yield of updated indications for endomyocardial biopsy and its clinical predictors in a Chinese cohort.\",\"authors\":\"Xuejing Duan, Yang Sun, Li Li, Lingmin Wu, Zhongkai Liao, Yuhui Zhang, Litian Yu, Yan Yao, Lei Song, Hongyue Wang\",\"doi\":\"10.1159/000545748\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>The challenging and restrictive settings have been proposed in the updated indications for endomyocardial biopsy (EMB), but no data shows its performance. This study aimed to evaluate the diagnostic yield and find its clinical predictors.</p><p><strong>Methods: </strong>All EMB performed between 2018 and 2022 were reviewed. Their clinical scenario and diagnostic yield were categorized retrospectively. Repeated and inadequate biopsies were excluded. Multivariate analysis was used to find the predictors.</p><p><strong>Results: </strong>A total of 681 cases were collected (median age 44.0 years, 65.5% male) and 230 cases (33.8%) yielded specific diagnosis. The higher yield (52.8%) was found in clinically suspected myocarditis while no significant difference between cases with and without acute unstable hemodynamics (66.7% vs 47.1%; P=0.130). There was a much higher yield in unexplained restrictive or hypertrophic cardiomyopathy (RCM/HCM) with suspected infiltrative or storage disorder compared to those without (86.2% vs 10.3%; P<0.001). Dilated cardiomyopathy showed a lower yield, with or without recent-onset moderate-to-severe cardiac dysfunction (13.6% vs 16.3%; P=1.000). The same was true for unexplained atrioventricular block and ventricular arrhythmias (AVB/VA), with or without obvious structural abnormalities (8.2% vs 10.3%; P=0.675). On multivariate analysis, diffuse late gadolinium enhancement (odds ratio [OR] 4.14, 95% confidence interval [CI] 1.86-9.25; P=0.001), time course of disease ≤12 months (OR 3.31, 95% CI 1.75-5.57; P<0.001), elevated(≥1250 pg/ml)NT-proBNP (OR 2.91, 95% CI 1.67-5.06; P<0.001), and elevated (>0.068 ng/ml) hs-cTnI (OR 2.37, 95% CI 1.33-4.22; P=0.004) were independently associated with diagnostic yield.</p><p><strong>Conclusion: </strong>Our results partially support the restrictive settings. EMB can achieve higher yield for unexplained RCM/HCM with suspected infiltrative or storage disorder, as well as strictly defined clinically suspected myocarditis, even in hemodynamically stable patients. However, the restrictive settings of unexplained AVB/VA and dilated cardiomyopathy did not show a clear advantage in diagnostic yield. The predictors this study found may help clinicians in selecting adequate candidates.</p>\",\"PeriodicalId\":9391,\"journal\":{\"name\":\"Cardiology\",\"volume\":\" \",\"pages\":\"1-16\"},\"PeriodicalIF\":1.9000,\"publicationDate\":\"2025-04-22\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12105824/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Cardiology\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1159/000545748\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cardiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1159/000545748","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
在更新的心内膜心肌活检(EMB)适应症中提出了具有挑战性和限制性的设置,但没有数据显示其性能。本研究旨在评估诊断率并寻找其临床预测因子。方法:回顾2018年至2022年期间进行的所有EMB。回顾性分析其临床表现及诊断率。排除重复和不充分的活检。采用多变量分析寻找预测因素。结果:共收集病例681例(中位年龄44.0岁,男性65.5%),确诊病例230例(33.8%)。临床疑似心肌炎患者的检出率较高(52.8%),急性血流动力学不稳定与非急性血流动力学不稳定患者的检出率无显著差异(66.7% vs 47.1%;P = 0.130)。原因不明的限制性或肥厚性心肌病(RCM/HCM)疑似浸润性或贮积性疾病的发生率远高于无浸润性或贮积性疾病的患者(86.2% vs 10.3%;P0.068 ng/ml) hs-cTnI (OR 2.37, 95% CI 1.33-4.22;P=0.004)与诊断产率独立相关。结论:我们的结果部分支持限制性设置。对于不明原因的RCM/HCM疑似浸润性或储存障碍,以及临床严格定义的疑似心肌炎,即使是血流动力学稳定的患者,EMB也能获得更高的产率。然而,原因不明的AVB/VA和扩张型心肌病的限制性条件在诊断率上没有明显的优势。本研究发现的预测因子可以帮助临床医生选择合适的候选人。
Diagnostic yield of updated indications for endomyocardial biopsy and its clinical predictors in a Chinese cohort.
Introduction: The challenging and restrictive settings have been proposed in the updated indications for endomyocardial biopsy (EMB), but no data shows its performance. This study aimed to evaluate the diagnostic yield and find its clinical predictors.
Methods: All EMB performed between 2018 and 2022 were reviewed. Their clinical scenario and diagnostic yield were categorized retrospectively. Repeated and inadequate biopsies were excluded. Multivariate analysis was used to find the predictors.
Results: A total of 681 cases were collected (median age 44.0 years, 65.5% male) and 230 cases (33.8%) yielded specific diagnosis. The higher yield (52.8%) was found in clinically suspected myocarditis while no significant difference between cases with and without acute unstable hemodynamics (66.7% vs 47.1%; P=0.130). There was a much higher yield in unexplained restrictive or hypertrophic cardiomyopathy (RCM/HCM) with suspected infiltrative or storage disorder compared to those without (86.2% vs 10.3%; P<0.001). Dilated cardiomyopathy showed a lower yield, with or without recent-onset moderate-to-severe cardiac dysfunction (13.6% vs 16.3%; P=1.000). The same was true for unexplained atrioventricular block and ventricular arrhythmias (AVB/VA), with or without obvious structural abnormalities (8.2% vs 10.3%; P=0.675). On multivariate analysis, diffuse late gadolinium enhancement (odds ratio [OR] 4.14, 95% confidence interval [CI] 1.86-9.25; P=0.001), time course of disease ≤12 months (OR 3.31, 95% CI 1.75-5.57; P<0.001), elevated(≥1250 pg/ml)NT-proBNP (OR 2.91, 95% CI 1.67-5.06; P<0.001), and elevated (>0.068 ng/ml) hs-cTnI (OR 2.37, 95% CI 1.33-4.22; P=0.004) were independently associated with diagnostic yield.
Conclusion: Our results partially support the restrictive settings. EMB can achieve higher yield for unexplained RCM/HCM with suspected infiltrative or storage disorder, as well as strictly defined clinically suspected myocarditis, even in hemodynamically stable patients. However, the restrictive settings of unexplained AVB/VA and dilated cardiomyopathy did not show a clear advantage in diagnostic yield. The predictors this study found may help clinicians in selecting adequate candidates.
期刊介绍:
''Cardiology'' features first reports on original clinical, preclinical and fundamental research as well as ''Novel Insights from Clinical Experience'' and topical comprehensive reviews in selected areas of cardiovascular disease. ''Editorial Comments'' provide a critical but positive evaluation of a recent article. Papers not only describe but offer critical appraisals of new developments in non-invasive and invasive diagnostic methods and in pharmacologic, nutritional and mechanical/surgical therapies. Readers are thus kept informed of current strategies in the prevention, recognition and treatment of heart disease. Special sections in a variety of subspecialty areas reinforce the journal''s value as a complete record of recent progress for all cardiologists, internists, cardiac surgeons, clinical physiologists, pharmacologists and professionals in other areas of medicine interested in current activity in cardiovascular diseases.