Cor Vasa 2011, 53(11):623-629 | DOI: 10.33678/cor.2011.157

Endomyocardial biopsy in recent dilated cardiomyopathy - evaluation of baseline characteristics of the first 50 patients

Jan Krejčí^1,*, Petr Hude¹, Lenka Špinarová¹, Eva Ozábalová¹, Alžběta Sirotková², Víta Žampachová², Eva Němcová³, Tomáš Freiberger³, Ladislav Pecen⁴, Jiří Vítovec¹

¹ I. interní kardioangiologická klinika, ICRC, FN u sv. Anny, Lékařská fakulta Masarykovy univerzity, Brno

² I. patologicko-anatomický ústav FN u sv. Anny, Lékařská fakulta Masarykovy univerzity, Brno

³ Centrum kardiovaskulární a transplantační chirurgie, Brno

⁴ Mezinárodní centrum klinického výzkumu (ICRC), Brno, Česká republika

Introduction: In about one half of patients with dilated cardiomyopathy (DCM), myocardial inflammation (myocarditis) is detected on biopsy. It is often challenging to diagnose myocarditis but modern evaluation methods including endomyocardial biopsy (EMB) and magnetic resonance imaging make the diagnosis much easier.

Aim: To evaluate bioptic findings in patients with recent non-ischemic heart failure and to compare the baseline clinical, echocardiographic, hemodynamic and some laboratory parameters in the groups with and without confirmed myocarditis.

Methods: The study population comprised 50 patients with recent DCM who underwent - besides standard investigations - a detailed echocardiographic evaluation using pulse wave tissue Doppler imaging (TDI), right-heart catheterization and right ventricular EMB. Bioptic specimens were examined histologically, immunohistochemically and using molecular genetic evaluation by polymerase chain reaction (PCR) method. The patients were divided into two groups according to the EMB findings - inflammatory cardiomyopathy (ICM) group and non-inflammatory dilated cardiomyopathy (DCM) group - and these two groups were then compared.

Results: 28 of 50 (i.e., 56%) patients suffered from myocardial inflammation and were thus classified as having ICM while 22 (44%) were diagnosed with non-inflammatory DCM. Viral genome was detected in the myocardium of 29 (58%) patients. Of all viruses, parvovirus B19 (PVB19) was found the most often. Patients with DCM had a larger left ventricular diastolic (70 ± 8 mm vs. 64 ± 9 mm) and systolic (61 ± 8 mm vs. 56 ± 10 mm) diameter than patients with ICM. Statistically significant differences between the groups were also found concerning left ventricular end-diastolic volume (EDV; 262 ± 63 ml [DCM] vs. 218 ± 67 ml [ICM]), left ventricular end-systolic volume (ESV; 197 ± 55 ml [DCM] vs. 160 ± 59 ml [ICM]) and right ventricular diameter (36 ± 5 [DCM] vs. 33 ± 5 mm [ICM]; p < 0.05 in all cases). The duration of symptoms was shorter in the ICM than in the DCM group (2.9 ± 3.2 vs. 4.3 ± 3.0; p < 0.05). Lower mean pulmonary artery pressure (MPA; 22 ± 8 mmHg vs. 30 ± 10 mmHg; p < 0.01) and pulmonary capillary wedge pressure (PCW; 15 ± 7 mmHg vs. 20 ± 9 mmHg; p < 0.05) were obtained in the ICM than in the DCM group.

Conclusion: In our population, recent DCM had inflammatory origin in 56% cases. Viral genome was found in the myocardium of 58% patients. Compared with ICM patients, non-inflammatory DCM patients had larger left ventricular systolic and diastolic diameter, larger left ventricular EDV and ESV and also larger right ventricular dimension. ICM patients had shorter symptom duration and their MPA and PCW pressures were lower. No significant differences between the groups were detected concerning other clinical, laboratory and echocardiographic parameters including TDI characteristics.

Keywords: Dilated cardiomyopathy; Inflammatory cardiomyopathy; Endomyocardial biopsy; Echocardiography; Right-heart catheterization

Published: November 1, 2011  Show citation