Abstract 14526: Contribute and Risks of Left Ventricular Endomyocardial Biopsy in Patients with Cardiomyopathies. A Retrospective Study Over a 28-Year Period
Introduction: Use of left ventricular (LV) endomyocardial biopsy (EMB) for the investigation of cardiomyopathies is currently discouraged as considered more risky and less contributive than right ventricular (RV) biopsy. Hypothesis: We assessed the hypothesis that LVEMB is safe and highly contributive, reporting our single-center experience on a large population of patients over a 28-year period.
Methods: In our center from 1983 to 2010, 4221 patients were submitted to a diagnostic EMB. In particular 2396 (56.8%) underwent a biventricular EMB, 1153 (27.3%) a selective LVEMB and 672 (15.9%) a selective RVEMB. Rate of complications and histological findings were retrospectively analysed.
Results: Periprocedural major complications were 0.30% for LVEMB and 0.29% for RVEMB. No patient died. LVEMB showed a lower incidence of cardiac perforation with cardiac tamponade compared with RVEMB (p=0.046). The most frequent major complication of LVEMB was brain embolization (0.24%) with transient cerebral ischemia without permanent damage and was significantly reduced pretreating the patient with high dose aspirin. In patients who received a biventricular EMB, LVEMB showed diagnostic histopathologic findings in 96.3% of cases while RVEMB in 71.4%. In particular, when the structural and/or functional abnormalities affected exclusively or predominantly the LV the diagnostic yield of LVEMB raised to 97.8% while for RVEMB decreased to 53% (p<0.001). Conversely, if the RV was also involved by the disease the diagnosis was reached in 98.1% of LVEMB and 96.5% of RVEMB.This was particularly evident for myocarditis, idiopathic and specific dilated cardiomyopathies and for restrictive cardiomyopathies such as endomyocardial fibrosis, sarcoidosis and idiopathic restrictive cardiomyopathy. In amyloidosis, haemochromatosis, cardiac glycogenosis and Fabry disease the histological abnormalities were always detectable in both ventricles.
Conclusions: In conclusion, LVEMB is a safe procedure with very low transient complications comparable to RVEMB. It should be preferred to RVEMB in patients with cardiomyopathies and clinically preserved RV.
- © 2012 by American Heart Association, Inc.