Key result
Endomyocardial biopsies had an overall diagnostic yield of 58%, with a non-significant trend toward higher yield in left-side (64%) versus right-side (45%) biopsies (p=0.346).
Why the study?
Endomyocardial biopsies remain the gold standard for diagnosing underlying heart failure etiology when non-invasive techniques are inconclusive, but advances in non-invasive diagnostic testing may alter the need for biopsies.
Cohort (n=57)
No
Absolute Event Rate: 64% vs 45%
p-value: p=0.346
Endomyocardial biopsy provides a high diagnostic yield (58%) with acceptable complication rates in patients with unexplained cardiomyopathy, particularly for identifying amyloidosis.
Modest endomyocardial biopsy yield with nonsignificant side difference warrants caution; leaves open optimal sampling site pending prospective data.
Background: Endomyocardial biopsies (EMBs) remain the golden standard to diagnose underlying pathophysiologic process in heart failure (HF), when potential therapeutic decisions cannot be made by non-invasive techniques. However, changes in the field of non-invasive diagnostic testing might have an impact on the need for performing an EMB in certain scenarios.Methods: We performed a retrospective analysis of consecutive EMBs performed in a single, non-academic, tertiary-care centre. EMBs were performed between February 2009 and March 2018. Baseline characteristics including non-invasive imaging and hemodynamic profile were assessed. Indications of EMBs were analysed in accordance with the 2007-AHA/ACC/ESC-scientific statement on EMBs.Results: A total of 57 patients (74% male) were included. The overall diagnostic yield was 58%, with a trend towards a higher yield in left-side (64%) versus right-side EMBs (45%; p = .346). The majority of patients (88%) underwent EMBs for a class IIa-recommendation, 9% for a class-I recommendation and the remaining patients for a class IIb-indication. Of the EMBs for a class IIa indication, 82% (n = 47) was for an unexplained restrictive cardiomyopathy, in which 53% (n = 25) revealed a diagnosis (of whom n = 23 patients had amyloidosis). Subtyping of the EMBs with a pathologic diagnosis of amyloidosis revealed that 52% (n = 12) had transthyretin amyloidosis (ATTR) and 43% (n = 10) had light-chain amyloidosis (AL). Overall one major (1.7%) and one minor (1.7%) complication occurred following the EMB-procedure.Conclusions: When following the AHA/ACC/ESC-scientific statement on EMBs, the performance of EMBs had a high diagnostic yield, with acceptable complication rates. However, in patients presenting with an unexplained restricted cardiomyopathy, technetium-labelled bone scanning could offer a non-invasive approach to establishing the diagnosis of ATTR, mitigating the need for EMBs in a subset of patients.
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Ramaekers et al. (2019) conducted a cohort in Unexplained cardiomyopathy (n=57). Left-side endomyocardial biopsies vs. Right-side endomyocardial biopsies was evaluated on Diagnostic yield (p=0.346). Endomyocardial biopsies had an overall diagnostic yield of 58%, with a non-significant trend toward higher yield in left-side (64%) versus right-side (45%) biopsies (p=0.346).
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