Abstract 1884: One-Year Prognosis in Patients with Markedly Reduced Left Ventricular Function: Association with Results of Endomyocardial Biopsy
Background: A significant proportion of patients (pts) with dilated cardiomyopathy (DCM) has viral persistence or inflammation in their endomyocardial biopsy (EMB) specimens. Since EMB is still not routinely used in the evaluation of heart failure pts, it is the aim of this study to examine the proportion of viral persistence or inflammation and one year prognosis in all pts admitted for evaluation of non-ischemic heart failure including EMB at the Clinical Division of Cardiology, Innsbruck Medical University.
Methods and results: All 74 pts (age 45±12 years) underwent coronary angiography and left or right ventricular biopsy. EMB specimens underwent immunohistological assessment and polymerase chain reaction for detection of the most frequent cardiotropic agents. In 35% of pts viral genom was detected (parvovirus n=25, chlamydia pneumonia n=1), inflammation (>14 lymphocytes or macrophages/mm2, WHF criteria) was observed in 19 patients. All pts had markedly reduced left ventricular ejection fraction (25±7%), increased NT-proBNP values (2369±2638pg/ml) and high NYHA class (2.9±0.9). Accordingly, pts were divided into 4 groups: group 1 comprised pts without any inflammation or virus detection (n=35), group 2 were pts with autoreactive myocarditis (virus-negative, but inflamed myocardium) (n=13), group 3 consisted of virus-positive pts without inflammation (n=20) and pts with virus-positive myocarditis formed group 4 (n=6). All major cardiovascular events (MACE; cardiovascular death, assist device implantation, heart transplantation and rehospitalisation due to cardiac decompensation) during one year were recorded (n=10). Kaplan-Meier curves demonstrated an increased amount of cardiovascular events in group 4 when compared to the other groups (6% vs. 0% vs. 10% vs. 33%; p=0.055). When patients were divided according to virus status, patients without virus detection tended to have fewer cardiovascular events compared to patients with virus persistence (4% vs. 15%; p=0.089)
Conclusion: In this study viral persistence was associated with increased MACE. Pts with virus-positive myocarditis had a worse short-term prognosis. Data from endomyocardial biopsy in pts with reduced left ventricular function is of prognostic relevance.