Indications and diagnostic yield of endomyocardial biopsies for unexplained cardiomyopathy, a single center
Jobbe Ramaekers1, Joyce Janssens1, Lise Waumans2
1Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium.
Insights
Endomyocardial biopsies (EMBs) are valuable for diagnosing heart failure when non-invasive methods fail. However, technetium-labelled bone scanning may reduce the need for EMBs in specific cases of unexplained restrictive cardiomyopathy.
Area of Science:
- Cardiology
- Pathology
- Diagnostic Imaging
Background:
- Endomyocardial biopsies (EMBs) are the gold standard for diagnosing heart failure (HF) when non-invasive techniques are insufficient.
- Advancements in non-invasive diagnostics may alter the necessity of EMBs in certain clinical scenarios.
Purpose of the Study:
- To retrospectively analyze the diagnostic yield and safety of EMBs.
- To evaluate the impact of current guidelines on EMB indications and outcomes.
- To explore the role of non-invasive imaging in diagnosing specific cardiac conditions.
Main Methods:
- Retrospective analysis of 57 consecutive EMBs performed between February 2009 and March 2018.
- Assessment of patient baseline characteristics, non-invasive imaging, and hemodynamic profiles.
- Analysis of EMB indications based on the 2007 AHA/ACC/ESC scientific statement.
Main Results:
- Overall diagnostic yield of EMBs was 58%.
- In unexplained restrictive cardiomyopathy, EMBs had a 53% diagnostic yield, with amyloidosis (ATTR and AL subtypes) being a common finding.
- Complication rates were low: one major (1.7%) and one minor (1.7%) complication.
Conclusions:
- EMBs demonstrate a high diagnostic yield and acceptable safety profile when performed according to established guidelines.
- Technetium-labelled bone scanning presents a potential non-invasive alternative for diagnosing transthyretin amyloidosis (ATTR), potentially reducing the need for EMBs in select patients.
Abstract:
Background: Endomyocardial biopsies (EMBs) remain the golden standard to diagnose underlying pathophysiologic process in heart failure (HF), when potential therapeutic decisions cannot be made by non-invasive techniques. However, changes in the field of non-invasive diagnostic testing might have an impact on the need for performing an EMB in certain scenarios.Methods: We performed a retrospective analysis of consecutive EMBs performed in a single, non-academic, tertiary-care centre. EMBs were performed between February 2009 and March 2018. Baseline characteristics including non-invasive imaging and hemodynamic profile were assessed. Indications of EMBs were analysed in accordance with the 2007-AHA/ACC/ESC-scientific statement on EMBs.Results: A total of 57 patients (74% male) were included. The overall diagnostic yield was 58%, with a trend towards a higher yield in left-side (64%) versus right-side EMBs (45%; p = .346). The majority of patients (88%) underwent EMBs for a class IIa-recommendation, 9% for a class-I recommendation and the remaining patients for a class IIb-indication. Of the EMBs for a class IIa indication, 82% (n = 47) was for an unexplained restrictive cardiomyopathy, in which 53% (n = 25) revealed a diagnosis (of whom n = 23 patients had amyloidosis). Subtyping of the EMBs with a pathologic diagnosis of amyloidosis revealed that 52% (n = 12) had transthyretin amyloidosis (ATTR) and 43% (n = 10) had light-chain amyloidosis (AL). Overall one major (1.7%) and one minor (1.7%) complication occurred following the EMB-procedure.Conclusions: When following the AHA/ACC/ESC-scientific statement on EMBs, the performance of EMBs had a high diagnostic yield, with acceptable complication rates. However, in patients presenting with an unexplained restricted cardiomyopathy, technetium-labelled bone scanning could offer a non-invasive approach to establishing the diagnosis of ATTR, mitigating the need for EMBs in a subset of patients.
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