MYOCARDIAL BIOPSY IN GENERAL CARE CLINIC: PATIENTS SELECTION, THE RESULTS, SIGNIFICANCE FOR TREATMENT STRATEGY

Aim. To analyze the results of first 50 endomyocardial biopsies (EMB) in general care clinic, to clarify the selection criteria and procedure role in management decision in patients with various noncoronarogenic diseases of myocardium. Material and methods. Totally 50 patients included, who had been underwent EMB during 2007-2014 (31 men, mean age 44,3±13,5). Investigation included the level of anticardiac antibodies (n=49), DNA of herpes group viruses and parvovirus B19 by PCR in blood (n=40) and myocardium (n=49), scintigraphy of myocardium (n=20), MDCT (n=21), MRI (n=17), coronary arteriography (n=22), genetician consultation (n=15). EMB of the right ventricle was done using biopsy forceps STANDARD 5.5 F 104 FEMORAL (Cordis). The materials were coloured with hematoxyline-eosine, picrofucsine by Van Hison, Schiff reactives, Pearls, red congo. The study was approved by the Ethics Comitteeof FMSMU. Results. Indications for EMB were set for 3 groups of patients: 1. With dilated cardiomyopathy (DCMP) as a syndrome, including the probability of acute/ subacute myocarditis (n=7), allergic myocarditis (n=1), myocarditis with myocardial infarction (n=1), vasculitis (n=3), possible myocarditis in long-lasting course of DCMP (n=9), in patients with non-compact myocardium, myodystrophy of Emeri-Dreyfus and possible arrhythmogenic dysplasia of the right ventricle (n=7). 2. With "idiopathic" rhythm and conduction disorders (n=18), including high probability of myocarditis (n=13), vasculitis (n=2), necessity for differentiation of myocarditis and genetic cardiomyopathies (n=3). 3. With the syndrome of primary myocardial hypertrophy (n=3). EMB was informative in all patients, myocarditis found in 82,6%.
Conclusion. The criteria for high diagnostic value of EMB is nosological way of selection. In addition to current scenarios it is aimfull to perform EMB if clinically significant ischemia with non-changed coronary arteries, with suspected myocarditis in patients with genetic cardiomyopathies, inborn defects, CHD and other established heart diseases. The EMB results define the tactics of medication and surgical treatment.

1. Weinberg M, Fell EH, Lynfield J. Diagnostic biopsy of the pericardium and myocardium. AMAArchSurg 1958; 76: 825-9.

2. Cooper LT, Baughman KL, Feldman AM et al. The role of endomyocardial biopsy in the management of cardiovascular disease: a scientific statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology. Endorsed by the Heart Failure Society of America and the Heart Failure Association of the European Society of Cardiology. J Am Coll Cardiol. 2007; 50(19): 1914-31.

3. Chimenti C, Frustaci A. Contribution and risks of left ventricular endomyocardial biopsy in patients with cardiomyopathies: a retrospective study over a 28-year period. Circulation. 2013; 128(14): 1531-41.

4. Caforio AL, Pankuweit S, Arbustini E, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J 2013; 34(33): 2636-48.

5. Aretz HT, Billingham ME, Edwards WD et al. Myocarditis. A histopathologic definition and classification. Am J Cardiovasc Pathol. 1987; 1(1): 3-14.

6. Maisch B, Portig I, RisticAetal. Definition of inflammatory cardiomyopathy (myocarditis): on the way to consensus. A status report. Herz. 2000; 25(3): 200-9.

7. Bennett MK, Gilotra NA, Harrington С et al. Evaluation of the role of endomyocardial biopsy in 851 patients with unexplained heart failure from 2000-2009. Circ Heart Fail. 2013; 6(4): 676-84.

8. Frustaci A, Caldarulo M, Buffon A et al. Cardiac biopsy in patients with "primary" atrial fibrillation. Histologic evidence of occult myocardial diseases. Chest. 1991; 100(2): 303-6.

9. Frustaci A, Chimenti C, Bellocci Fetal. Histological substrate of atrial biopsies in patients with lone atrial fibrillation. Circulation. 1997; 96(4): 1180-4.

10. Egorov DF, Adrianov AV, Malkina EV. Endomyocardial biopsy of the right chambers in children with progressive cardiac arrhythmias and conduction disturbances. SPb .: Chelovek, 2006, 96 p.

11. Vasichkina ES, Mitrofanova LB, Tatarsky RB, et al. Endomyocardial biopsy of the right chambers in children with progressive cardiac arrhythmias. Vestnik of Arrhythmology, 2014; 76:17-23.

12. LukA, Metawee M, Ahn Eet al. Do clinical diagnoses correlate with pathological diagnoses in cardiac transplant patients? The importance of endomyocardial biopsy. Can J Cardiol. 2009; 25(2): e48-54.

13. Grochotova W, Lebedev DS, Mitrofanova LB. The effectiveness of radiofrequency ablation of ventricular tachyarrhythmias in patients with latent myocarditis. Abstracts III All-Russian scientific-practical conference with international participation "Noncoronary heart disease: diagnosis, treatment, prevention", 2011: p. 20.

14. Arbustini E, Gavazzi A, Dal Bello В et al. Ten-year experience with endomyocardial biopsy in myocarditis presenting with congestive heart failure: frequency, pathologic characteristics, treatment and follow-up. G Ital Cardiol. 1997; 27(3): 209-23.

15. Frustaci A, Russo MA, Chimenti С Diagnostic contribution of left ventricular endomyocardial biopsy in patients with clinical phenotype of hypertrophic cardiomyopathy. Hum Pathol. 2013; 44(1): 133-41.

16. Frustaci A, Verardo R, Caldarulo M et al. Myocarditis in hypertrophic cardiomyopathy patients presenting acute clinical deterioration. Eur Heart J. 2007; 28(6): 733-40.

17. Blagova OV, Nedostup AV. Modern masks of myocarditis (from clinical syndromes to diagnosis). Russian Journal of Cardiology, 2014,5 (109): 13-22.