Key result
Endomyocardial biopsy identified patients with giant cell myocarditis at an earlier stage (6.6 vs 11.0 months, p=0.034) and with less impaired cardiac function compared to diagnosis during heart transplantation.
Why the study?
Giant cell myocarditis is a rare, rapidly progressing cardiomyopathy with high mortality if not diagnosed and treated in time.
Does endomyocardial biopsy allow for earlier diagnosis and detection of giant cell myocarditis at a stage of better preserved cardiac function compared to diagnosis at the time of heart transplantation?
Observational (n=12)
No
Does endomyocardial biopsy allow for earlier diagnosis and detection of giant cell myocarditis at a stage of better preserved cardiac function compared to diagnosis at the time of heart transplantation?
Absolute Event Rate: 6.6% vs 11%
p-value: p=0.034
Giant cell myocarditis is frequently misdiagnosed, but early utilization of endomyocardial biopsy can significantly reduce diagnostic delay and identify the disease before progression to end-stage heart failure.
May support EMB for earlier GCM detection before severe dysfunction; hypothesis-generating and requires prospective validation.
Aims: Giant cell myocarditis (GCM) is a rare, rapidly progressing cardiomyopathy with high mortality, if not diagnosed and treated in time. We analyzed the progression and clinical manifestations of patients with definitive diagnosis of GCM. Methods and Result: We enrolled 12 patients diagnosed with GCM in the explanted heart during heart transplantation (HTx) or by endomyocardial biopsy (EMB) and collected information on demographic data, cardiac structure and function, arrhythmias, preliminary diagnosis, and delay of the diagnosis. Seven cases were diagnosed from biopsy samples during HTx, and five cases were diagnosed through EMB. Before the diagnosis of GCM based on pathological analysis, these patients had been incorrectly diagnosed with arrhythmogenic right ventricular cardiomyopathy ( n = 5), dilated cardiomyopathy ( n = 2), ventricular tachycardia ( n = 2), viral myocarditis ( n = 1), cardiac amyloidosis ( n = 1), and ischemic cardiomyopathy ( n = 1) based on clues such as symptoms, arrhythmia, and cardiac imaging. Patients diagnosed with GCM through EMB had a shorter symptom-onset-to-diagnosis time (6.6 ± 2.7 months) and milder heart damage (left ventricular ejection fraction, 47.2 ± 8.8%) than those diagnosed during HTx (11.0 ± 3.3 months, P = 0.034; 31.4 ± 10.9%, P = 0.024). Conclusion: GCM is easily misdiagnosed as other types of myocarditis and cardiomyopathy. Pathological examination of the myocardium is the most reliable diagnostic method for GCM. Endocardial biopsy can identify patients with GCM at an earlier stage.
No takes yet. Share an insight, caveat, or question.
Liu et al. (2021) conducted an observational in Giant Cell Myocarditis (n=12). Endomyocardial biopsy (EMB) vs. Heart transplantation (HTx) biopsy was evaluated on Symptom-onset-to-diagnosis time (months) (p=0.034). Endomyocardial biopsy identified patients with giant cell myocarditis at an earlier stage (6.6 vs 11.0 months, p=0.034) and with less impaired cardiac function compared to diagnosis during heart transplantation.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: