ESC heart failure · 2025
Clinical impact of follow-up endomyocardial biopsy in myocarditis during or after immune-suppressive therapy.
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Baritussio Anna, Giordani Andrea Silvio, Rizzo Stefania, Vicenzetto Cristina, De Gaspari Monica, Carturan Elisa, Toscano Giuseppe, Scognamiglio Federico, Tarantini Giuseppe, Iliceto Sabino, Basso Cristina, Marcolongo Renzo, Caforio Alida Linda Patrizia
Аннотация
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.
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.