Endomyocardial biopsy: safety and prognostic utility in paediatric and adult myocarditis in the European Society of Cardiology EURObservational Research Programme Cardiomyopathy and Myocarditis Long-Term Registry-Reference-Cited by-同舟云学术

Endomyocardial biopsy: safety and prognostic utility in paediatric and adult myocarditis in the European Society of Cardiology EURObservational Research Programme Cardiomyopathy and Myocarditis Long-Term Registry

Published:2024-04-10 Issue:28 Volume:45 Page:2548-2569
ISSN:0195-668X
Container-title:European Heart Journal
language:en
Short-container-title:

Author:

Caforio Alida L P¹^ORCID,Kaski Juan P²,Gimeno Juan R³,Elliott Perry M⁴,Laroche Cecile⁵,Tavazzi Luigi⁶,Tendera Michal⁷,Fu Michael⁸,Sala Simone⁹,Seferovic Petar M¹⁰,Heliö Tiina¹¹,Calò Leonardo¹²,Blagova Olga¹³,Amin Ahmad¹⁴,Kindermann Ingrid¹⁵,Sinagra Gianfranco¹⁶,Frustaci Andrea¹⁷,Bonnet Daniel¹⁸,Charron Philippe¹⁹,Maggioni Aldo P⁵²⁰, ,Ferrari R,Alonso A,Bax J,Blomström-Lundqvist C,Gielen S,Lancellotti P,Maggioni A P,Maniadakis N,Pinto F,Ruschitzka F,Tavazzi L,Vardas P,Weidinger F,Zeymer U,Vahanian A,Budaj A,Dagres N,Danchin N,Delgado V,Emberson J,Friberg O,Gale C P,Heyndrickx G,Iung B,James S,Kappetein A P,Maggioni A P,Maniadakis N,Nagy K V,Parati G,Petronio A-S,Pietila M,Prescott E,Ruschitzka F,Van de Werf F,Weidinger F,Zeymer U,Gale C P,Beleslin B,Budaj A,Chioncel O,Dagres N,Danchin N,Emberson J,Erlinge D,Glikson M,Gray A,Kayikcioglu M,Maggioni A P,Nagy K V,Nedoshivin A,Petronio A-P,Roos-Hesselink J W,Wallentin L,Zeymer U,Popescu B A,Adlam D,Caforio A L P,Capodanno D,Dweck M,Erlinge D,Glikson M,Hausleiter J,Iung B,Kayikcioglu M,Ludman P,Lund L,Maggioni A P,Matskeplishvili S,Meder B,Nagy K V,Nedoshivin A,Neglia D,Pasquet A A,Roos-Hesselink J W,Rossello F J,Shaheen S M,Torbica A,Caforio Alida,Gimeno Blanes Juan Ramon,Charron Philippe,Elliott Perry,Kaski Juan Pablo,Maggioni Aldo P,Tavazzi Luigi,Tendera Michal,Pihkala J,Ojala T,Hiippala A,Jarvinen T,Lommi J,Helio T,Sinisalo J,Bonnet D,Khraiche D,Szezepanski I,Charron P,Mankikian S,Maupain C,Collet J-P,Gandjbakhch E,Kerneis M,Pruny J-F,Bauer A,Pfeiffer B,Felix S B,Beug D,Dorr M,Kaczmarek S,Lehnert K,Pedersen A-L,Bruder M,Gorenflo M,Arnold R,Uhl S,Ziesenitz V,Jung A,Roesch E,Böhm M,Kindermann I,Linicus Y,Werner C,Neurath B,Schild-Ungerbuehler M,Kindermann M,Kaski J P,Norrish G,Field E,Elliott P,Lorenzini M,Watkinson O,Wicks E,Anastasakis A,Ritsatos K,Vlagkouli V,Rammos S,Kourelis G,Giannakopoulou A,Karanasios E,Papachristou P,Papadopoulos G,Servos G,Maleki M,Noohi Bezanjani F,Amin A,Naderi N,Parsaee M,Taghavi S,Ghadrdoost B,Jafari S,Khoshavi M,Della Bella P,Sala S,Peretto G,Calabro R,Pacileo G,Russo M G,Limongelli G,Esposito A,Gragnano F,Gravino R,Marrazzo T,Masarone D,Pazzanese V,Rubino M,Tramonte S,Valente F,Caiazza M,Calabro P,Cirillo A,Trimarco B,Losi M-A,Di Nardo C,Giamundo A,Pacelli F,Canciello G,Iliceto S,Caforio A,Calore C,Leoni L,Perazzolo Marra M,Rigato I,Tarantini G,Schiavo A,Testolina M,Fedele F,Frustaci A,Alfarano M,Chimenti C,Drago F,Baban A,Calò L,Lanzillo C,Martino A,Uguccioni M,Zachara E,Halasz G,Re F,Sinagra G,Carriere C,Merlo M,Ramani F,Kavoliuniene A,Krivickiene A,Tamuleviciute-Prasciene E,Viezelis M,Celutkiene J,Balkeviciene L,Laukyte M,Paleviciute E,Asselbergs F,De Jonge N,Kirkels J H,Van Der Heijden J,Van Laake L,Sammani A,Mizia-Stec K,Tendera M,Wybraniec M,Czekaj A,Sikora-Puz A,Skoczynska A,Rubis P,Wisniowska-Smialek S,Grzybowski J,Ojrzynska N,Bilinska Z,Chmielewski P,Foss-Nieradko B,Michalak E,Stepien-Wojno M,Mazek B,Brzezinska-Rajszys G,Ziolkowska L,Boruc A,Plodzien E,Rocha Lopes L,Almeida A R,Cruz I,Gomes A C,Pereira A R,Ginghina C,Jurcut R,Apetrei E,Militaru S,Mircea Coman I,Mursa A,Popescu B A,Frigy A,Fehervari L,Fogarasi Z,Kocsis I,Szabo I A,Nikitin I,Resnik E,Komissarova M,Lazarev V,Shebzukhova M,Ustyuzhanin D,Blagova O,Alieva I,Kulikova V,Lutokhina Y,Pavlenko E,Varionchik N,Zaklyazminskaya E,Dzemeshkevich S,Kolbasova E,Kotlukova N,Rusinova V,Ristic A D,Seferovic P M,Pavlovic A,Radovanovic G,Simeunovic D,Zivkovic I,Milinkovic I,Gran Ipina F,Roses Noguer F,Albert Brotons D,Cequier A,Salazar-Mendiguchia J,Gonzalez J,Manito N,Garcia-Pavia P,Briceno A,Cobo-Marcos M,Dominguez F,Gimeno Blanes J R,Castro F J,Munoz Esparza C,Sabater Molina M,Sorli García M,Lopez Cuenca D,Ripoll-Vera T,Alvarez J,Nunez J,Gomez Y,Sanchez Fernandez P L,Villacorta E,Avila C,Bravo L,Diaz-Pelaez E,Gallego-Delgado M,Garcia-Cuenllas L,Plata B,Fu M,Canpolat U

Affiliation:

1. Cardiology, Department of Cardiological, Thoracic and Vascular Sciences and Public Health, University of Padova , Via N Giustiniani, 2, Padova 35100 , Italy

2. Cardiology, University College London and Great Ormond Street Hospital for Children , London , UK

3. Cardiac Department, Hospital Clínico Universitario Virgen de la Arrixaca , Murcia , Spain

4. Institute of Cardiovascular Science, University College London and St. Bartholomew’s Hospital , London , UK

5. European Society of Cardiology, EURObservational Research Programme , Biot , France

6. GVM Care& Research, Maria Cecilia Hospital , Cotignola , Italy

7. Department of Cardiology and Structural Heart Disease, School of Medicine in Katowice, Medical University of Silesia , Katowice , Poland

8. Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Gothenburg University , Gothenburg , Sweden

9. Myocarditis Unit, Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute , Milan , Italy

10. Serbian Academy of Sciences and Arts, Heart Failure Center, Faculty of Medicine, Belgrade University Medical Center , Belgrade , Serbia

11. Heart and Lung Center, Helsinki University Hospital and University of Helsinki , Helsinki , Finland

12. Department of Cardiology, Policlinico Casilino , Roma , Italy

13. V.N. Vinogradov Faculty Therapeutic Clinic, I.M. Sechenov First Moscow State Medical University (Sechenov University) , Moscow , Russian Federation

14. Department of Heart Failure and Transplantation, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences , Tehran , Iran

15. Department of Internal Medicine III (Cardiology, Angiology and Intensive Care), Saarland University Medical Center, Saarland University , Homburg/Saar , Germany

16. Cardiothoracovascular Department, University of Trieste , Trieste , Italy

17. IRCCS San Raffaele , Rome , Italy

18. M3C-Necker Enfants Malades, AP-HP, Université de Paris Cité , Paris , France

19. Sorbonne Université, Centre de Référence des Maladies Cardiaques Héréditaires ou Rares, Assistance Publique-Hôpitaux de Paris, ICAN, Inserm UMR1166, Hôpital Pitié-Salpêtrière , Paris , France

20. ANMCO Research Center , Florence , Italy

Abstract

Abstract Background and Aims Contemporary multicentre data on clinical and diagnostic spectrum and outcome in myocarditis are limited. Study aims were to describe baseline features, 1-year follow-up, and baseline predictors of outcome in clinically suspected or biopsy-proven myocarditis (2013 European Society of Cardiology criteria) in adult and paediatric patients from the EURObservational Research Programme Cardiomyopathy and Myocarditis Long-Term Registry. Methods Five hundred eighty-one (68.0% male) patients, 493 adults, median age 38 (27–52) years, and 88 children, aged 8 (3–13) years, were divided into 3 groups: Group 1 (n = 233), clinically suspected myocarditis with abnormal cardiac magnetic resonance; Group 2 (n = 222), biopsy-proven myocarditis; and Group 3 (n = 126) clinically suspected myocarditis with normal or inconclusive or no cardiac magnetic resonance. Baseline features were analysed overall, in adults vs. children, and among groups. One-year outcome events included death/heart transplantation, ventricular assist device (VAD) or implantable cardioverter defibrillator (ICD) implantation, and hospitalization for cardiac causes. Results Endomyocardial biopsy, mainly right ventricular, had a similarly low complication rate in children and adults (4.7% vs. 4.9%, P = NS), with no procedure-related death. A classical myocarditis pattern on cardiac magnetic resonance was found in 31.3% of children and in 57.9% of adults with biopsy-proven myocarditis (P < .001). At 1-year follow-up, 11/410 patients (2.7%) died, 7 (1.7%) received a heart transplant, 3 underwent VAD (0.7%), and 16 (3.9%) underwent ICD implantation. Independent predictors at diagnosis of death or heart transplantation or hospitalization or VAD implantation or ICD implantation at 1-year follow-up were lower left ventricular ejection fraction and the need for immunosuppressants for new myocarditis diagnosis refractory to non–aetiology-driven therapy. Conclusions Endomyocardial biopsy was safe, and cardiac magnetic resonance using Lake Louise criteria was less sensitive, particularly in children. Virus-negative lymphocytic myocarditis was predominant both in children and adults, and use of immunosuppressive treatments was low. Lower left ventricular ejection fraction and the need for immunosuppressants at diagnosis were independent predictors of unfavourable outcome events at 1 year.

Funder

Abbott Vascular Int

Amgen Cardiovascular

AstraZeneca

Bayer AG

Boehringer Ingelheim

Boston Scientific

Bristol-Myers Squibb and Pfizer Alliance

Daiichi Sankyo Europe GmbH

The Alliance Daiichi Sankyo Europe GmbH and Eli Lilly and Company

Edwards

Gedeon Richter Plc