An Evaluation of the Role of Endomyocardial Biopsy in 851 Patients With Unexplained Heart Failure From 2000-2009.
Circ Heart Fail. 2013 Jun 3;
Authors: Bennett MK, Gilotra NA, Harrington C, Rao S, Dunn JM, Freitag TB, Halushka MK, Russell SD
Abstract
BACKGROUND: -Endomyocardial biopsy (EMB) is often considered when the etiology of heart failure cannot be determined by non-invasive testing. Uncertainty remains about the diagnostic and clinical utility of EMB in various clinical scenarios. METHODS AND RESULTS: -We examined the characteristics of a cohort of patients with unexplained heart failure who underwent EMB at a tertiary care medical center. We categorized each patient into a clinical scenario as outlined by the 2007 AHA/ACC/ESC guidelines and determined the number of times EMB provided a diagnosis or altered the clinical course. A total of 851 patients underwent EMB from 2000-2009. Overall, 25.5% of EMB provided a diagnosis and 22.7% changed clinical course. Heart failure associated with unexplained restrictive cardiomyopathy was the most common clinical scenario, comprising 33.6% (286/851) of EMB, and eighty-four (29.4%) of these EMB were diagnostic. EMB for unexplained heart failure of less than two weeks duration had a diagnostic yield at 35% (39/109). There were four uncommon scenarios where EMB had a high diagnostic and clinical yield. There were 16 complications for an overall rate of 1.9%. CONCLUSIONS: -We confirm that EMB is useful in acute onset unexplained cardiomyopathy. We demonstrate a role for EMB in suspected infiltrative disease and in the management of rare clinical scenarios such as suspected hypersensitivity myocarditis, anthracycline cardiomyopathy, cardiac tumors, and ARVD/C. Our results suggest low utility of EMB in chronic heart failure that responds to usual care.
PMID: 23733916 [PubMed - as supplied by publisher]