Key result
LV endomyocardial biopsy linked to ~46% lower risk of tamponade or effusion vs RV biopsy.
Why the study?
It remains contentious whether right ventricle endomyocardial biopsy is safer than left ventricle endomyocardial biopsy for diagnosing myocarditis and investigating nonischaemic cardiomyopathies.
Does left ventricle endomyocardial biopsy reduce procedural complications compared to right ventricle endomyocardial biopsy in patients requiring cardiac tissue evaluation?
Meta-Analysis (n=6,308)
Does left ventricle endomyocardial biopsy reduce procedural complications compared to right ventricle endomyocardial biopsy in patients requiring cardiac tissue evaluation?
Odds Ratio: 0.54 (95% CI 0.31–0.93)
p-value: p=0.03
Left ventricle biopsy reduces the risk of perforation and tamponade but carries a higher, albeit rare, risk of cerebrovascular embolization compared to the traditional right ventricle approach.
LV-EMB may reduce tamponade risk versus RV approach; extends observational safety data but leaves optimal site selection open for randomized trials.
Background: Endomyocardial biopsy (EMB) is an invasive procedure used to diagnose myocarditis and investigate other nonischaemic cardiomyopathies. However, it is still contentious whether right ventricle endomyocardial biopsy (RV-EMB) is safer than left ventricle endomyocardial biopsy (LV-EMB). Therefore, we aimed to perform an updated meta-analysis comparing the outcomes of LV-EMB vs RV-EMB in patients submitted to this procedure. Methods: We searched PubMed, Embase, and Cochrane Central in January 2023 for studies comparing the outcomes of patients submitted to LV-EMB and/or RV-EMB. Outcomes were major and minor complications after the procedure: death, cardiac tamponade requiring pericardiocentesis, pericardial effusion without pericardiocentesis, stroke, transient ischemic attack, arrhythmias as permanent or transient atrioventricular block, atrial fibrillation, ventricular fibrillation, chest pain and local complications. Statistical analysis was performed using RevMan 5.1.7. Heterogeneity was assessed with I² statistics. The risk of bias of the studies has been evaluated with the ROBINS-I tool. Results: = 0.03; I² = 20%) after the procedure were significantly lower in patients submitted to LV-EMB compared with RV-EMB. Conclusions: In conclusion, a minor rate of pericardial perforation was observed during LV-EMB compared to RV-EMB. It was also observed that LV-EMB provides a high diagnostic yield in diagnosing myocarditis and other cardiomyopathies. Lay summary: Endomyocardial biopsy (EMB) is an invasive procedure used to diagnose cardiac diseases. Our aim is to study which side of the heart is safer for this procedure.•Biopsy of left ventricle presented less perforation of the heart wall.•Some studies suggest a better diagnostic performance of the left ventricle biopsy.
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Neves et al. (2023) conducted a meta-analysis in Patients undergoing endomyocardial biopsy for conditions such as myocarditis, cardiomyopathy, and heart transplant surveillance (n=6,308). Left ventricle endomyocardial biopsy vs. Right ventricle endomyocardial biopsy was evaluated on Cardiac tamponade requiring pericardiocentesis and/or pericardial effusion (OR 0.54, 95% CI 0.31-0.93, p=0.03). Left ventricle endomyocardial biopsy was associated with a significantly lower risk of cardiac tamponade and/or pericardial effusion compared to right ventricle biopsy (OR 0.54, 95% CI 0.31-0.93, p=0.03).
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