Contribution and Risks of Left Ventricular Endomyocardial Biopsy in Patients with Cardiomyopathies: A Retrospective Study over a 28-Year Period
Background—Use of left ventricular (LV) endomyocardial biopsy (EMB) for investigation of cardiomyopathies is currently discouraged as considered more risky and equally contributive than right ventricular (RV) biopsy. Aim of our study is to report our experience on advantages and disadvantages of this option.
Methods and Results—In our center from 1983 to 2010, 4221 patients underwent diagnostic EMB. In particular 2396 (56.8%) underwent biventricular EMB, 1153 (27.3%) selective LVEMB and 672 (15.9%) selective RVEMB. Rate of complications and histologic findings were retrospectively analyzed. Periprocedural major complications rate (perforation with or without cardiac tamponade, embolization) was 0.33% for LVEMB and 0.45% for RVEMB, with a significant decrease in rate of major complication with time (from, respectively, 1.6% and 1.9% in 1983-1988 to 0 and 0.3% in 2007-2013, p<0.001 for both), denoting a steep learning curve. No patient died. When the structural and functional abnormalities affected exclusively the LV the diagnostic yield of LVEMB was 97.8% compared with 53% of RVEMB. Conversely, when the echocardiographic presence of increased wall thickness and/or local or global ventricular dilation and/or dysfunction involved also the RV, the diagnosis was reached in 98.1 % of LVEMB and 96.5% of RVEMB. This discrepancy was particularly evident for myocarditis, while in infiltrative and storage diseases the histologic abnormalities were always detectable in both ventricles.
Conclusions—LVEMB is a safe procedure with very low transient complications comparable to RVEMB. It appears diagnostically more contributive than RVEMB in patients with cardiomyopathies and clinically preserved RV.
- Received January 18, 2013.
- Revision received July 25, 2013.
- Accepted July 30, 2013.