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Can right ventricular endomyocardial biopsy predict left ventricular fibrosis beforehand in dilated cardiomyopathy?

Kisaki Amemiya1,2, Taka-Aki Matsuyama2, Hatsue Ishibashi-Ueda1,3

  • 1Department of Pathology, National Cerebral and Cardiovascular Center, Osaka, Japan.

ESC Heart Failure
|January 18, 2024
PubMed

Insights

Right ventricular endomyocardial biopsy (RV-EMB) can predict left ventricular (LV) fibrosis in dilated cardiomyopathy (DCM). This finding aids in assessing DCM prognosis using accessible biopsy methods.

Area of Science:

  • Cardiology
  • Cardiac Pathology
  • Diagnostic Imaging

Background:

  • Left ventricular (LV) myocardial fibrosis is a key prognostic indicator in dilated cardiomyopathy (DCM).
  • Accurate assessment of LV fibrosis is crucial for managing DCM patients.

Purpose of the Study:

  • To determine if right ventricular endomyocardial biopsy (RV-EMB) fibrosis can predict the extent of LV fibrosis in DCM patients.
  • To evaluate the correlation between RV-EMB fibrosis and LV fibrosis in excised hearts.

Main Methods:

  • Compared fibrosis extent in 70 RV-EMB specimens with LV fibrosis in 52 explanted hearts and 18 autopsied hearts from DCM patients.
  • Utilized image analysis to quantify fibrosis area ratio in biopsies and excised hearts.
  • Assessed cardiovascular magnetic resonance-late gadolinium enhancement (LGE) distribution in the intraventricular septum.

Main Results:

  • A significant positive correlation was found between fibrosis area ratio in RV-EMB and LV excised hearts (r=0.82, P<0.0001).
  • RV-EMB fibrosis also correlated significantly with diffuse LGE patterns (r=0.71, P=0.003).
  • Multivariate analysis confirmed RV-EMB fibrosis predicts LV fibrosis, even after adjusting for time between biopsy and excision.

Conclusions:

  • Fibrosis identified in RV-EMB strongly correlates with LV fibrosis extent in DCM.
  • RV-EMB serves as a valuable tool for predicting LV fibrosis, a critical prognostic factor in DCM.
  • This accessible biopsy technique may improve prognostic assessment in dilated cardiomyopathy.
Abstract

Keywords:
AutopsyCardiovascular magnetic resonanceDilated cardiomyopathyEndomyocardial biopsyFibrosisHeart transplantation

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