Endomyocardial Biopsy-Based Inflammatory Phenotypes Predict Outcomes in Virus-Negative Dilated and Inflammatory
Christian Baumeier1, Felicitas Escher2, Ganna Aleshcheva1
1Institute for Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany.
JACC. Heart Failure
|June 30, 2026
Summary
Quantitative analysis of inflammatory phenotypes in virus-negative cardiomyopathy (CMi) using endomyocardial biopsies (EMBs) offers crucial prognostic insights. Higher immune cell counts correlate with worse outcomes, aiding risk stratification for heart failure patients.
Area of Science:
- Cardiology
- Immunology
- Pathology
Background:
- Inflammatory cardiomyopathy (CMi) is a significant cause of heart failure.
- Prognostic value of distinct inflammatory phenotypes in CMi is not fully understood.
- Endomyocardial biopsies (EMBs) with advanced immunohistochemistry may enhance risk stratification.
Purpose of the Study:
- To assess the prognostic significance of quantitative inflammatory phenotypes in virus-negative CMi.
- To determine if specific immune cell markers in EMBs predict outcomes in CMi patients.
Main Methods:
- Analysis of 478 virus-negative CMi patients from 1,467 undergoing EMB.
- Histology and immunohistochemistry (CD3+, Macrophage-1+, CD45R0+, LFA-1+) to characterize myocardial inflammation.
- Defined prognostic thresholds for each marker.
- Multivariable Cox regression and Kaplan-Meier analyses for associations with mortality and ventricular dysfunction.
Main Results:
- Elevated CD3+ T cells (≥7.8 cells/mm²) were the strongest predictor of mortality and LVEF decline (HR: 1.037).
- Increased Macrophage-1+ (≥40), CD45R0+ (≥21), or LFA-1+ (≥12.5) cells independently predicted poorer outcomes (P < 0.01).
- These markers identified inflammation in 26% of patients otherwise undiagnosed, showing a dose-response relationship between inflammatory burden and prognosis.
Conclusions:
- Quantitative inflammatory phenotyping of EMBs provides independent prognostic information in virus-negative CMi.
- Findings reflect the natural disease course and support refined biopsy diagnostics for risk stratification.
- Personalized treatment strategies can be informed by these detailed prognostic insights.
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