Robert M A van der Boon1, Wijnand K den Dekker1, Christiaan L Meuwese2,3, Roberto Lorusso4, Jan H von der Thüsen5, Alina C Constantinescu1, Olivier C Manintveld1, Thijs S R Delnoij4, Joris J van der Heijden3, Nicolas M D A van Mieghem1, Corstiaan A den Uil1,2,6. 1. Department of Cardiology (R.M.A.v.d.B., W.K.d.D., A.C.C., O.C.M., N.M.D.A.v.M., C.d.U.), Erasmus Medical Center Rotterdam, the Netherlands. 2. Department of Intensive Care (C.d.U., C.L.M.), Erasmus Medical Center Rotterdam, the Netherlands. 3. Department of Cardiology and Intensive Care, Utrecht Medical Center, the Netherlands (C.L.M., J.J.v.d.H.). 4. Department of Cardiology and Intensive Care, Maastricht University Medical Center, the Netherlands (R.L., T.S.R.D.). 5. Department of Pathology (J.H.v.d.T.), Erasmus Medical Center Rotterdam, the Netherlands. 6. Department of Intensive Care, Maasstad Hospital, Rotterdam, the Netherlands (C.d.U.).
Abstract
BACKGROUND: Endomyocardial biopsy (EMB) has an important role in determining the pathogenesis of new-onset acute heart failure (new-AHF) when noninvasive testing is impossible. However, data on safety and histopathologic outcomes in patients requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is lacking. METHODS: A retrospective, multicenter cohort of patients undergoing EMB while requiring VA-ECMO for new-AHF between 1990 and 2020 was compared with a cohort of nontransplant related biopsies not requiring VA-ECMO. Primary end point of the study was to determine the safety of EMB. Additionally, we describe the underlying pathogenesis causing new-AHF based on histopathologic examination of the samples obtained. RESULTS: A total of 23 patients underwent EMB while requiring VA-ECMO (10.0%), 125 (54.3%) during an unplanned admission, and 82 (35.7%) in elective setting. Major complications occurred in 8.3% of all procedures with a significantly higher rate in patients requiring VA-ECMO (26.1% versus 8.0% versus 3.7%, P=0.003) predominately due to the occurrence of sustained ventricular tachycardia or need of resuscitation (13.0% versus 3.2% versus 1.2%, P=0.02). EMB led to a histopathologic diagnosis in 78.3% of the patients requiring VA-ECMO which consisted primarily of patients with myocarditis (73.9%). CONCLUSIONS: EMB in patients requiring VA-ECMO can be performed albeit with a substantial risk of major complications. The risk of the procedure was offset by a histopathologic diagnosis in 78.3% of the patients, which for the majority consisted of patients with myocarditis. The important therapeutic and prognostic implications of establishing an underlying pathogenesis causing new-AHF in this population warrant further refinement to improve procedural safety.
BACKGROUND: Endomyocardial biopsy (EMB) has an important role in determining the pathogenesis of new-onset acute heart failure (new-AHF) when noninvasive testing is impossible. However, data on safety and histopathologic outcomes in patients requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is lacking. METHODS: A retrospective, multicenter cohort of patients undergoing EMB while requiring VA-ECMO for new-AHF between 1990 and 2020 was compared with a cohort of nontransplant related biopsies not requiring VA-ECMO. Primary end point of the study was to determine the safety of EMB. Additionally, we describe the underlying pathogenesis causing new-AHF based on histopathologic examination of the samples obtained. RESULTS: A total of 23 patients underwent EMB while requiring VA-ECMO (10.0%), 125 (54.3%) during an unplanned admission, and 82 (35.7%) in elective setting. Major complications occurred in 8.3% of all procedures with a significantly higher rate in patients requiring VA-ECMO (26.1% versus 8.0% versus 3.7%, P=0.003) predominately due to the occurrence of sustained ventricular tachycardia or need of resuscitation (13.0% versus 3.2% versus 1.2%, P=0.02). EMB led to a histopathologic diagnosis in 78.3% of the patients requiring VA-ECMO which consisted primarily of patients with myocarditis (73.9%). CONCLUSIONS: EMB in patients requiring VA-ECMO can be performed albeit with a substantial risk of major complications. The risk of the procedure was offset by a histopathologic diagnosis in 78.3% of the patients, which for the majority consisted of patients with myocarditis. The important therapeutic and prognostic implications of establishing an underlying pathogenesis causing new-AHF in this population warrant further refinement to improve procedural safety.
Authors: Enrico Ammirati; Andrea Buono; Francesco Moroni; Lorenzo Gigli; John R Power; Michele Ciabatti; Andrea Garascia; Eric D Adler; Maurizio Pieroni Journal: Curr Cardiol Rep Date: 2022-02-24 Impact factor: 3.955
Authors: Joanna Płonka; Ryszard Gawda; Jerzy Sacha; Jarosław Bugajski; Tomasz Brzostowicz; Maciej Molsa; Tomasz Czarnik; Karin Klingel; Marek Gierlotka Journal: Cardiol J Date: 2022-06-28 Impact factor: 3.487