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. 2022 Nov;75(11):874-882.
doi: 10.1016/j.rec.2022.01.015. Epub 2022 May 3.

Endomyocardial biopsy-confirmed myocarditis and inflammatory cardiomyopathy: clinical profile and prognosis

[Article in English, Spanish]
Fernando Domínguez  1 , Rafael Cobas Paz  2 , Clara Salas Antón  3 , María Colomés Iess  4 , Juan Francisco Oteo-Domínguez  5 , Luis Escobar-López  6 , Fernando de Frutos  6 , Marta Cobo-Marcos  6 , Esther González-López  6 , Francisco José Hernández-Pérez  5 , Cristina Mitroi  5 , Ana Briceño  5 , Mercedes Rivas-Lasarte  5 , Manuel Gómez-Bueno  6 , Pablo García-Pavía  7 , Javier Segovia-Cubero  6
Affiliations

Endomyocardial biopsy-confirmed myocarditis and inflammatory cardiomyopathy: clinical profile and prognosis

[Article in English, Spanish]
Fernando Domínguez et al. Rev Esp Cardiol (Engl Ed). 2022 Nov.

Abstract

Introduction and objectives: Endomyocardial biopsy (EMB) is the only technique able to establish an etiological diagnosis of myocarditis or inflammatory cardiomyopathy (ICM). The aim of this study was to analyze the clinical profile, outcomes, and prognostic factors of patients with suspected myocarditis/ICM undergoing EMB.

Methods: We retrospectively analyzed the clinical characteristics, histological findings, and follow-up data of all patients with suspected myocarditis or ICM who underwent EMB between 1997 and 2019 in a Spanish tertiary hospital. The diagnostic yield was compared using the Dallas criteria vs immunohistochemical criteria (IHC).

Results: A total of 99 patients underwent EMB (67% male; mean age, 42±15 years; mean left ventricular ejection fraction [LVEF], 34%±14%). Myocarditis or ICM was confirmed in 28% with application of the Dallas criteria and in 54% with the IHC criteria (P <.01). Lymphocytic myocarditis was diagnosed in 47 patients, eosinophilic myocarditis in 6, sarcoidosis in 3, and giant cell myocarditis in 1 patient. After a median follow-up of 18 months, 23 patients (23%) required heart transplant (HTx), a left ventricular assist device (LVAD), and/or died. Among the patients with IHC-confirmed myocarditis, 21% required HTx/LVAD or died vs 7% of those without inflammation (P=.056). The factors associated with a worse prognosis were baseline LVEF ≤ 30%, left ventricular end-diastolic diameter ≥ 60mm, and NYHA III-IV, especially in the presence of inflammation.

Conclusions: EMB allows an etiological diagnosis in more than half of patients with suspected myocarditis/ICM when IHC techniques are used. IHC-confirmed inflammation adds prognostic value and helps to identify patients with a higher probability of developing complications.

Keywords: Anatomía patológica; Biopsia endomiocárdica; Endomyocardial biopsy; Histopathology; Immunohistochemistry; Inmunohistoquímica; Miocarditis; Myocarditis.

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