Key result
Transcatheter RV endomyocardial biopsy in children carries a 3% major complication rate.
Why the study?
The study was conducted to assess findings and outcomes in children with suspected cardiomyopathy or myocarditis undergoing cardiac catheterization with transcatheter right ventricular endomyocardial biopsy.
Does transcatheter right ventricular endomyocardial biopsy and hemodynamic assessment predict death or cardiac transplantation in children with suspected myocarditis or cardiomyopathy?
Cohort (n=81)
Does transcatheter right ventricular endomyocardial biopsy and hemodynamic assessment predict death or cardiac transplantation in children with suspected myocarditis or cardiomyopathy?
RV-EMB and invasive hemodynamics provide important diagnostic information and independent prognostic value for death or cardiac transplantation in children with suspected myocarditis or cardiomyopathy.
May inform risk stratification in pediatric cardiomyopathy; hypothesis-generating observational data leave causal prognostic role open.
Objective: The study objective is assessing findings and outcome in children with suspected cardiomyopathy (CMP) or myocarditis undergoing cardiac catheterization with transcatheter right ventricular endomyocardial biopsy (RV-EMB). Methods: All consecutive children undergoing cardiac catheterization with RV-EMB for suspected CMP/myocarditis between 2002–2021 were analysed regarding clinical presentation, cardiac biomarkers, periprocedural management, hemodynamic, histological/immunohistological findings, and outcome. Results: Eighty-five RV-EMBs were performed in 81 patients at a median age of 6.8 (IQR 9.9) years and a bodyweight of 20 (32.2) kg. Histological/immunohistological findings of RV-EMB revealed dilated CMP in 10 (12%), chronic myocarditis in 28 (33%), healing myocarditis in 5 (6%), acute myocarditis in 9 (11%), other heart muscle diseases in 23 (27%) (7 restrictive CMP, 5 hypertrophic CMP, 4 toxic/anthracycline-induced CMP, 4 endocardfibroelastosis, 1 arrhythmogenic right ventricular CMP, 1 laminin CMP, 1 haemangioma), no conclusive histology in 7 (8%), and normal histology in 3 (4%) patients. Median LVEDP was 17 mmHg (IQR 9), LAP 15 mmHg (10), and PVR 1.83 (1.87) Wood Units/m2. There were 3 major complications (3%), all patients recovered without any sequelae. At follow-up (median 1153, IQR 1799 days) 47 (59%) patients were alive, 11 (13%) dead, 15 (18%) underwent cardiac transplantation, and 8 (9%) were lost to follow-up. Death/cardiac transplantation occurred within 3 years from RV-EMB. All patients with an acute myocarditis survived. NT-pro-BNP, echo parameters, and invasive hemodynamics correlate independently with death/cardiac transplant. Conclusion: Hemodynamic invasive data and morphological findings in RV-EMB complete clinical diagnosis in children with suspected CMP/myocarditis and provide important information for further clinical management.
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Callegari et al. (2022) conducted a cohort in Suspected cardiomyopathy or myocarditis (n=81). Transcatheter right ventricular endomyocardial biopsy (RV-EMB) was evaluated on Findings and outcome (including complications, death, and cardiac transplantation). Transcatheter right ventricular endomyocardial biopsy in children with suspected cardiomyopathy or myocarditis had a 3% major complication rate, with 13% mortality and 18% transplant rate at follow-up.
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