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Ferreira Neves HA, Yanaze Takamatsu G, Yuasa BS, Villatore VN, da Rocha GL, Lima Junior E. Right or left endomyocardial biopsy? A systematic review with meta-analysis about complications and safety. JHLT OPEN 2023; 2:100006. [PMID: 40144011 PMCID: PMC11935350 DOI: 10.1016/j.jhlto.2023.100006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 03/28/2025]
Abstract
Background Endomyocardial biopsy (EMB) is an invasive procedure used to diagnose myocarditis and investigate other nonischaemic cardiomyopathies. However, it is still contentious whether right ventricle endomyocardial biopsy (RV-EMB) is safer than left ventricle endomyocardial biopsy (LV-EMB). Therefore, we aimed to perform an updated meta-analysis comparing the outcomes of LV-EMB vs RV-EMB in patients submitted to this procedure. Methods We searched PubMed, Embase, and Cochrane Central in January 2023 for studies comparing the outcomes of patients submitted to LV-EMB and/or RV-EMB. Outcomes were major and minor complications after the procedure: death, cardiac tamponade requiring pericardiocentesis, pericardial effusion without pericardiocentesis, stroke, transient ischemic attack, arrhythmias as permanent or transient atrioventricular block, atrial fibrillation, ventricular fibrillation, chest pain and local complications. Statistical analysis was performed using RevMan 5.1.7. Heterogeneity was assessed with I² statistics. The risk of bias of the studies has been evaluated with the ROBINS-I tool. Results We included 6308 patients from 6 studies. The mean age was 49.8 years, with approximately 70% male patients. All studies were observational prospective or retrospective. Pericardial tamponade and/or pericardial effusion (odds ratio 0.54; 95% confidence interval 0.31-0.93; p = 0.03; I² = 20%) after the procedure were significantly lower in patients submitted to LV-EMB compared with RV-EMB. Conclusions In conclusion, a minor rate of pericardial perforation was observed during LV-EMB compared to RV-EMB. It was also observed that LV-EMB provides a high diagnostic yield in diagnosing myocarditis and other cardiomyopathies. Lay summary Endomyocardial biopsy (EMB) is an invasive procedure used to diagnose cardiac diseases. Our aim is to study which side of the heart is safer for this procedure.•Biopsy of left ventricle presented less perforation of the heart wall.•Some studies suggest a better diagnostic performance of the left ventricle biopsy.
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Abstract
Endomyocardial biopsy (EMB) is an invasive procedure originally developed for the monitoring of heart transplant rejection. Over the year, this procedure has gained a fundamental complementary role in the diagnostic work-up of several cardiac disorders, including cardiomyopathies, myocarditis, drug-related cardiotoxicity, amyloidosis, other infiltrative and storage disorders, and cardiac tumours. Major advances in EMB equipment and techniques for histological analysis have significantly improved diagnostic accuracy of EMB. In recent years, advanced imaging modalities such as echocardiography with three-dimensional and myocardial strain analysis, cardiac magnetic resonance and bone scintigraphy have transformed the non-invasive approach to diagnosis and prognostic stratification of several cardiac diseases. Therefore, it emerges the need to re-define the current role of EMB for diagnostic work-up and management of cardiovascular diseases. The aim of this review is to summarize current knowledge on EMB in light of the most recent evidences and to discuss current indications, including challenging scenarios encountered in clinical practice.
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Tyler Z, Guttmann OP, Savvatis K, Jones D, O'Mahony C. Is This the Prime Time for Transradial Access Left Ventricular Endomyocardial Biopsy? Interv Cardiol 2021; 16:e29. [PMID: 34733353 PMCID: PMC8548872 DOI: 10.15420/icr.2021.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 08/24/2021] [Indexed: 11/23/2022] Open
Abstract
Left ventricular endomyocardial biopsy (EMB) is an essential tool in the management of myocarditis and is conventionally performed via transfemoral access (TFA). Transradial access EMB (TRA-EMB) is a novel alternative and the authors sought to determine its safety and feasibility by conducting a systematic review of the literature. Medline was searched in 2020, and cohort demographics, procedural details and complications were extracted from selected studies. Four observational studies with a combined total of 496 procedures were included. TRA-EMB was most frequently performed with a sheathless MP1 guide catheter via the right radial artery. The most common complication was pericardial effusion (up to 11% in one study), but pericardial drainage for tamponade was rare (one reported case). Death and mitral valve damage have not been reported. TRA-EMB was successful in obtaining samples in 99% of reported procedures. The authors concluded that TRA-EMB is a safe and feasible alternative to TFA-EMB and the most common complication is uncomplicated pericardial effusion.
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Affiliation(s)
| | - Oliver P Guttmann
- St Bartholomew's Hospital London, UK.,UCL Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London London, UK
| | - Konstantinos Savvatis
- St Bartholomew's Hospital London, UK.,UCL Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London London, UK
| | | | - Constantinos O'Mahony
- St Bartholomew's Hospital London, UK.,UCL Centre for Heart Muscle Disease, Institute of Cardiovascular Science, University College London London, UK
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Göbel S, Schwuchow‐Thonke S, Jansen T, Karbach S, Emrich T, Gori T, Knies F, Schulz E, Münzel T, Keller K, Wenzel P. Safety of transradial and transfemoral left ventricular compared with transfemoral right ventricular endomyocardial biopsy. ESC Heart Fail 2020; 7:4015-4023. [PMID: 32949187 PMCID: PMC7754772 DOI: 10.1002/ehf2.13006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 08/05/2020] [Accepted: 08/26/2020] [Indexed: 12/19/2022] Open
Abstract
AIMS With the present study, we sought to determine the safety of three different endomyocardial biopsy (EMB) access routes in 514 patients admitted for diagnostic workup of heart failure of unknown aetiology. METHODS AND RESULTS In this retrospective monocentric cohort study, we analysed 514 consecutive patients with heart failure without evidence of significant coronary artery disease or valvular disease undergoing EMB between November 2013 and December 2018, stratified in three access route groups: transradial arterial left ventricular (LV-)EMB (323 patients), transfemoral LV-EMB (138 patients), and transfemoral right ventricular (RV-)EMB (53 patients). Patients undergoing selective transradial LV-EMB were older compared with patients undergoing selective transfemoral LV-EMB or RV-EMB [transradial LV-EMB: 56.0 (45.0/64.0) vs. transfemoral LV-EMB: 53 (42.5/64.5), P = 0.455; transradial LV-EMB: 56 (45.0/64.0) vs. RV-EMB: 53 (42.5/64), P = 0.695] and presented more often in New York Heart Association-functional class III and IV. A total of eight major complications including permanent atrioventricular block requiring pacemaker implantation, pericardial tamponade necessitating pericardiocentesis, stroke and transient cerebral ischaemic attack as well as severe valvular damage, vascular access site complications, and ventricular fibrillation were documented with no significant differences between the groups (8/514, 1.5%). Minor complications such as transient chest pain, non-sustained electrocardiogram abnormalities, and transient atrioventricular block were rare and equally distributed between groups. CONCLUSIONS Transradial LV-EMB is a safe procedure for experienced radial operators and non-inferior compared with transfemoral LV-EMB and RV-EMB. An accurate peri-procedural and post-procedural monitoring and follow-up care should be recommended for all patients undergoing this procedure in order to identify potential complications.
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Affiliation(s)
- Sebastian Göbel
- Department of CardiologyUniversity Medical Center MainzLangenbeckstr. 1Mainz55131Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine‐MainMainzGermany
| | - Sören Schwuchow‐Thonke
- Department of CardiologyUniversity Medical Center MainzLangenbeckstr. 1Mainz55131Germany
| | - Thomas Jansen
- Department of CardiologyUniversity Medical Center MainzLangenbeckstr. 1Mainz55131Germany
| | - Susanne Karbach
- Department of CardiologyUniversity Medical Center MainzLangenbeckstr. 1Mainz55131Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine‐MainMainzGermany
- Center for Thrombosis and HemostasisMainzGermany
| | - Tilman Emrich
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine‐MainMainzGermany
- Center for Diagnostic and Interventional RadiologyUniversity Medical Center MainzMainzGermany
| | - Tommaso Gori
- Department of CardiologyUniversity Medical Center MainzLangenbeckstr. 1Mainz55131Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine‐MainMainzGermany
| | - Finja Knies
- Department of CardiologyUniversity Medical Center MainzLangenbeckstr. 1Mainz55131Germany
| | - Eberhard Schulz
- Department of CardiologyUniversity Medical Center MainzLangenbeckstr. 1Mainz55131Germany
| | - Thomas Münzel
- Department of CardiologyUniversity Medical Center MainzLangenbeckstr. 1Mainz55131Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine‐MainMainzGermany
| | - Karsten Keller
- Department of CardiologyUniversity Medical Center MainzLangenbeckstr. 1Mainz55131Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine‐MainMainzGermany
| | - Philip Wenzel
- Department of CardiologyUniversity Medical Center MainzLangenbeckstr. 1Mainz55131Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine‐MainMainzGermany
- Center for Thrombosis and HemostasisMainzGermany
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Nobre Menezes M, Infante Oliveira E, Costa E Silva A, Brito D, Azevedo Coutinho MDC, Canas da Silva P, Pinto FJ. Transradial left ventricular endomyocardial biopsy feasibility, safety and clinical usefulness: Initial experience of a tertiary university center. Rev Port Cardiol 2020; 39:453-460. [PMID: 32753337 DOI: 10.1016/j.repc.2019.11.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 11/08/2019] [Accepted: 11/10/2019] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION AND OBJECTIVES Over the last decade, several studies have suggested that left ventricular endomyocardial biopsy is safer and has a higher diagnostic yield than transvenous right ventricular biopsy. In addition, recent publications indicate that the transradial approach is a feasible and safe alternative to the transfemoral approach for sampling the left ventricle. We report our initial experience with transradial endomyocardial biopsy with regards to feasibility, safety and usefulness. METHODS Single-center registry of consecutive patients undergoing intended transradial left endomyocardial biopsy. Clinical and technical data were collected prospectively, with a particular focus on success rate and complications. RESULTS Twenty-seven patients were screened for left ventricle biopsy. Twenty (25) were selected for an intended transradial approach (mean age 51±18 years old, 22 male). Success rate was 100% with no crossover to femoral approach. There were no major complications. Two patients experienced mild radial spasm. One of them also had a run of non-sustained ventricular tachycardia. Indication for biopsy was either myocarditis or cardiomyopathy of unknown etiology. The final diagnosis was acute lymphocytic myocarditis in five patients, chronic myocarditis in one patient, amyloid light-chain amyloidosis in four patients and transthyretin amyloidosis in six patients. Myocarditis was ruled out in eight patients and amyloidosis in one patient. CONCLUSIONS Transradial left ventricle endomyocardial biopsy is a very safe and feasible method of sampling the myocardium for histopathological analysis, with a good diagnostic yield and clinically meaningful results in properly selected patients.
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Affiliation(s)
- Miguel Nobre Menezes
- Serviço de Cardiologia, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal; CAML, CCUL, Faculdade de Medicina de Lisboa, Universidade de Lisboa, Portugal.
| | - Eduardo Infante Oliveira
- Serviço de Cardiologia, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal; CAML, CCUL, Faculdade de Medicina de Lisboa, Universidade de Lisboa, Portugal
| | - Artur Costa E Silva
- Serviço de Anatomia Patológica, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal
| | - Dulce Brito
- Serviço de Cardiologia, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal; CAML, CCUL, Faculdade de Medicina de Lisboa, Universidade de Lisboa, Portugal
| | - Maria da Conceição Azevedo Coutinho
- Serviço de Cardiologia, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal; CAML, CCUL, Faculdade de Medicina de Lisboa, Universidade de Lisboa, Portugal
| | - Pedro Canas da Silva
- Serviço de Cardiologia, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal; CAML, CCUL, Faculdade de Medicina de Lisboa, Universidade de Lisboa, Portugal
| | - Fausto J Pinto
- Serviço de Cardiologia, Centro Hospitalar Universitário Lisboa Norte, Lisboa, Portugal; CAML, CCUL, Faculdade de Medicina de Lisboa, Universidade de Lisboa, Portugal
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Nobre Menezes M, Infante Oliveira E, Costa e Silva A, Brito D, Azevedo Coutinho MDC, Canas da Silva P, Pinto FJ. Transradial left ventricular endomyocardial biopsy feasibility, safety and clinical usefulness: Initial experience of a tertiary university center. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.repce.2019.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Ong P, Safdar B, Seitz A, Hubert A, Beltrame JF, Prescott E. Diagnosis of coronary microvascular dysfunction in the clinic. Cardiovasc Res 2020; 116:841-855. [DOI: 10.1093/cvr/cvz339] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Abstract
The coronary microcirculation plays a pivotal role in the regulation of coronary blood flow and cardiac metabolism. It can adapt to acute and chronic pathologic conditions such as coronary thrombosis or long-standing hypertension. Due to the fact that the coronary microcirculation cannot be visualized in human beings in vivo, its assessment remains challenging. Thus, the clinical importance of the coronary microcirculation is still often underestimated or even neglected. Depending on the clinical condition of the respective patient, several non-invasive (e.g. transthoracic Doppler-echocardiography assessing coronary flow velocity reserve, cardiac magnetic resonance imaging, positron emission tomography) and invasive methods (e.g. assessment of coronary flow reserve (CFR) and microvascular resistance (MVR) using adenosine, microvascular coronary spasm with acetylcholine) have been established for the assessment of coronary microvascular function. Individual patient characteristics, but certainly also local availability, methodical expertise and costs will influence which methods are being used for the diagnostic work-up (non-invasive and/or invasive assessment) in a patient with recurrent symptoms and suspected coronary microvascular dysfunction. Recently, the combined invasive assessment of coronary vasoconstrictor as well as vasodilator abnormalities has been titled interventional diagnostic procedure (IDP). It involves intracoronary acetylcholine testing for the detection of coronary spasm as well as CFR and MVR assessment in response to adenosine using a dedicated wire. Currently, the IDP represents the most comprehensive coronary vasomotor assessment. Studies using the IDP to better characterize the endotypes observed will hopefully facilitate development of tailored and effective treatments.
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Affiliation(s)
- Peter Ong
- Department of Cardiology, Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376 Stuttgart, Germany
| | - Basmah Safdar
- Department of Emergency Medicine, Yale University, New Haven, CT, USA
| | - Andreas Seitz
- Department of Cardiology, Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376 Stuttgart, Germany
| | - Astrid Hubert
- Department of Cardiology, Robert-Bosch-Krankenhaus, Auerbachstr. 110, 70376 Stuttgart, Germany
| | - John F Beltrame
- The Queen Elizabeth Hospital Discipline of Medicine, University of Adelaide, Central Adelaide Local Health Network, Adelaide, Australia
| | - Eva Prescott
- Department of Cardiology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
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Choudhury T, Lurz P, Schäufele TG, Menezes MN, Lavi S, Tzemos N, Hartung P, Stiermaier T, Makino K, Bertrand OF, Gilchrist IC, Mamas MA, Bagur R. Radial versus femoral approach for left ventricular endomyocardial biopsy. EUROINTERVENTION 2019; 15:678-684. [DOI: 10.4244/eij-d-18-01061] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Abstract
BACKGROUND Patients with angina yet having unobstructed coronaries are found in ∼50% of cases undergoing invasive angiography. Coronary spasm and microvascular dysfunction can be responsible for the clinical presentation in ∼60% of cases. However, little is known about structural changes in the myocardium. The aim of this study was to describe findings in endomyocardial biopsies of symptomatic patients with unobstructed coronaries. PATIENTS AND METHODS We retrospectively analyzed a cohort of 1416 consecutive patients who underwent endomyocardial biopsy sampling and coronary angiography between 2002 and 2016 for various clinical indications. Of them, 309 patients had also undergone intracoronary acetylcholine testing (ACH-test). To be eligible for the study, patients had to have normal left ventricular ejection fraction, unobstructed coronaries and absence of viral genomes in the myocardium. RESULTS Among the final cohort of 33 (70% female, mean age 53) patients, the ACH-test revealed coronary microvascular spasm in 11 (33.3%) patients. Twelve (36.4%) patients had epicardial spasm and 10 (30.3%) had an uneventful ACH-test. Immunohistology revealed activated macrophages in 10 (30%) cases and activated endothelial cells as well as perivascular or interstitial fibrosis in 17 (52%). Myocardial hypertrophy was seen in nine (27%) patients, and smooth muscle cell proliferation was present in 11 (33%) cases. Compared with the rest of the cohort, patients with microvascular spasm significantly more often had activated endothelial cells (P=0.003). CONCLUSION This study gives unique insights into structural myocardial alterations in patients with angina, unobstructed coronaries and abnormal coronary vasomotion, suggesting that a combination of both structural and functional alterations is frequent.
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10
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Transradial Approach for Left Ventricular Endomyocardial Biopsy. Can J Cardiol 2018; 34:1283-1288. [DOI: 10.1016/j.cjca.2018.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 05/05/2018] [Accepted: 05/07/2018] [Indexed: 01/19/2023] Open
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Comparison of Utilization Trends, Indications, and Complications of Endomyocardial Biopsy in Native Versus Donor Hearts (from the Nationwide Inpatient Sample 2002 to 2014). Am J Cardiol 2018; 121:356-363. [PMID: 29197471 DOI: 10.1016/j.amjcard.2017.10.021] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 10/21/2017] [Accepted: 10/24/2017] [Indexed: 01/28/2023]
Abstract
Native heart endomyocardial biopsy (NH-EMB) is an infrequently performed procedure. The objective of this study is to describe utilization trends, indications, and complications associated with NH-EMB in the United States and compare them with transplanted heart endomyocardial biopsy (TH-EMB). Using the Healthcare Cost and Utilization Project National Inpatient Sample database, we identified 71,105 adult patients undergoing EMB in the inpatient setting in participating hospitals from 2002 to 2014. A total of 20,770 (29%) were performed on NHs (mean age 52.2 ± 15.3, 61% men). Approximately half of patients were white and mean Charlson co-morbidity index was 1.97 ± 1.6. Common indications for NH-EMB included a suspected primary cardiomyopathy (disorder confined to the myocardium), heart failure without cardiogenic shock, and acute myocarditis. Less common indications included heart failure with cardiogenic shock, unexplained heart failure with ventricular tachycardia or high-degree atrioventricular block, and cardiac neoplasms. Complications included pericardial effusion (3.8%), third-degree atrioventricular block (2.7%), vascular complications (1.9%), and deep venous thrombosis (3.5%), in others. Predictors of complications included presence of a cardiac malignant neoplasm, use of hemodynamic support, heart failure with ventricular tachyarrhythmias, and female gender. Compared with NH-EMB, TH-EMB was associated with lower rates of pericardial effusion, third-degree atrioventricular block, ventricular tachyarrhythmias requiring cardioversion, and higher rates of deep venous thrombosis, infections, and pneumothorax. NH-EMB utilization is low in the United States and constitutes less than 1/3 of all EMBs performed.
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Francis R, Lewis C. Myocardial biopsy: techniques and indications. Heart 2017; 104:950-958. [PMID: 29032361 DOI: 10.1136/heartjnl-2017-311382] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 08/15/2017] [Accepted: 09/17/2017] [Indexed: 12/27/2022] Open
Affiliation(s)
| | - Clive Lewis
- Transplant Unit, Papworth Hospital, Cambridge, UK
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Unterberg-Buchwald C, Ritter CO, Reupke V, Wilke RN, Stadelmann C, Steinmetz M, Schuster A, Hasenfuß G, Lotz J, Uecker M. Targeted endomyocardial biopsy guided by real-time cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2017; 19:45. [PMID: 28424090 PMCID: PMC5395773 DOI: 10.1186/s12968-017-0357-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 03/30/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Endomyocardial biopsies (EMB) are an important diagnostic tool for myocarditis and other infiltrative cardiac diseases. Routinely, biopsies are obtained under fluoroscopic guidance with a substantial radiation burden. Despite procedural success, there is a large sampling error caused by missing the affected myocardium. Therefore, multiple (>6) biopsies are taken in the clinical setting. In cardiovascular magnetic resonance (CMR), late gadolinium enhancement (LGE) depicts areas of affected myocardium in myocarditis or in other infiltrative cardiomyopathies. Thus, targeted biopsy under real-time CMR image guidance might reduce the problem of sampling error. METHODS Seven minipigs of the Goettingen strain underwent radiofrequency ablation in the left ventricle. At least two focal lesions were induced on the lateral wall in five and the apex in two animals. Each ablation lesion was created by two consecutive 30 sec ablations (max. 30 W, temperature 60-64 °C). Biopsies were taken immediately after lesion induction using a commercially available 7 F conventional bioptome under fluoroscopic guidance at the ablation site. Afterwards the animals underwent CMR and lesion visualization by LGE at 3T. The lesions were then targeted and biopsied under CMR-guidance using a MR-conditional bioptome guided by a steerable catheter. Interactive real-time (RT) visualization of the intervention on an in-room monitor was based on radial FLASH with nonlinear inverse reconstruction (NLINV) at a temporal resolution of 42 ms. All samples underwent a standard histological evaluation. RESULTS Radiofrequency ablation was successful in all animals. Fluoroscopy-guided biopsies were performed with a success rate of 6/6 minipigs - resulting in a nonlethal pericardial effusion in one animal. Visualization of radiofrequency lesions by CMR was successful in 7/7 minipig, i.e. at least one lesion was clearly visible. Localization and tracking of the catheters and the bioptome using interactive control of the imaging plane was achieved in 6/6 MP; however in the animal with a large pericardial effusion after EMB under fluoroscopy no further EMB was attempted for safety reasons. Biopsies under interactive RT-CMR guidance were successfully performed in 5/6 animals, in one animal the bioptome reached the lesion, however the forceps did not cut out a sample. Specimens obtained under CMR guidance contained part of the lesion in 6/15 (40%) myocardial specimens and in 4/5 (80%) animals in which samples were achieved. Conventional biopsies revealed ablation lesions in 4/17 (23.5%) specimens in 3/6 minipigs (50%). CONCLUSION Focal lesions induced by radiofrequency ablation in a minipig model are a useful tool for CMR-guided biopsy studies. In contrast to fluoroscopy, CMR provides excellent visualization of lesions. Interactive real-time CMR allows excellent passive tracking of the instruments and EMB provides significantly superior sampling accuracy compared to fluoroscopy-guided biopsies. Nonetheless, further improvements of MR-compatible bioptomes and guiding catheters are essential before applying this method in a clinical setting.
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Affiliation(s)
- Christina Unterberg-Buchwald
- University Medical Center Goettingen, Clinic of Cardiology and Pneumology, Goettingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Goettingen, Berlin, Germany
- University Medical Center Goettingen, Institute for Diagnostic and Interventional Radiology, Goettingen, Germany
| | - Christian Oliver Ritter
- DZHK (German Centre for Cardiovascular Research), Partner Site Goettingen, Berlin, Germany
- University Medical Center Goettingen, Institute for Diagnostic and Interventional Radiology, Goettingen, Germany
| | - Verena Reupke
- Department of Experimental Animal Medicine, Georg-August University, Goettingen, Germany
| | - Robin Niklas Wilke
- DZHK (German Centre for Cardiovascular Research), Partner Site Goettingen, Berlin, Germany
- University Medical Center Goettingen, Institute for Diagnostic and Interventional Radiology, Goettingen, Germany
| | - Christine Stadelmann
- Department of Neuropathology, University Medical Center Goettingen, Goettingen, Germany
| | - Michael Steinmetz
- DZHK (German Centre for Cardiovascular Research), Partner Site Goettingen, Berlin, Germany
- University Medical Center Goettingen, Clinic of Pediatric Cardiology and Intensive Care Medicine, Goettingen, Germany
| | - Andreas Schuster
- University Medical Center Goettingen, Clinic of Cardiology and Pneumology, Goettingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Goettingen, Berlin, Germany
| | - Gerd Hasenfuß
- University Medical Center Goettingen, Clinic of Cardiology and Pneumology, Goettingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Goettingen, Berlin, Germany
| | - Joachim Lotz
- DZHK (German Centre for Cardiovascular Research), Partner Site Goettingen, Berlin, Germany
- University Medical Center Goettingen, Institute for Diagnostic and Interventional Radiology, Goettingen, Germany
| | - Martin Uecker
- DZHK (German Centre for Cardiovascular Research), Partner Site Goettingen, Berlin, Germany
- University Medical Center Goettingen, Institute for Diagnostic and Interventional Radiology, Goettingen, Germany
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Kherad B, Köhncke C, Spillmann F, Post H, Noutsias M, Pieske B, Krackhardt F, Tschöpe C. Postprocedural radial artery occlusion rate using a sheathless guiding catheter for left ventricular endomyocardial biopsy performed by transradial approach. BMC Cardiovasc Disord 2016; 16:253. [PMID: 27931184 PMCID: PMC5146854 DOI: 10.1186/s12872-016-0432-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 12/02/2016] [Indexed: 01/25/2023] Open
Abstract
Background For coronary interventions the arterial access via the radial artery is associated with fewer vascular access site complications, and has been shown to reduce major bleeding when compared to the femoral approach. But the endomyocardial biopsy (EMB) approach is usually done by a transfemoral or cervical access known to be associated with an increased risk of artery puncture and its potential complications (i.e., false aneurysm, artery-venous fistula) and needs post-procedural immobilization. A transradial approach for EMBs is not standardized. The aim of our study is to validate safety and efficacy of the transradial access approach for left ventricular EMB, and to define patients eligible for a safe and successful procedure. Methods and Results We evaluated the transradial access using a 7.5 F sheathless multipurpose guiding catheter to obtain EMBs from the left ventricle (LV). 18 patients were included. The transradial success rate was 100% (18/18). There were no periprocedural cardiac complications. Immediate post-procedural ambulation could be achieved in all patients. Although radial artery pulse was confirmed by ultrasonic vascular Doppler after removal of the guide in 100% (18/18) of the patients, 50% (9/18) of the patients showed occlusion of the radial artery RAO) by duplex sonography proximal to the access site. 33% (3/9) of the patients in the RAO group and 11,1% (1/9) of the patients in the patent radial artery (RAP) group, respectively, experienced mild pain after the procedure in the right lower arm. Colour Doppler ultrasonography of the right radial artery performed 24 h after the procedure revealed radial occlusion in 50% (9/18) of the patients. The diameter of the radial artery was significantly smaller in the RAO group (p = 0,034), peak systolic velocity (PSV) of the right ulnar artery was significantly higher in the RAO group (p = 0.012). Peak systolic velocity of the opposite radial artery was significantly lower in the RAO group (p = 0,045). Gender, sex, diabetes, radial artery inner diameter ≤2.5 mm and lower peak systolic velocity of < 50 cm/s are predictors of RAO. Conclusion The present study demonstrates the safety and efficacy of a transradial access for EMB using a highly hydrophilic sheathless guiding catheter.
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Affiliation(s)
- Behrouz Kherad
- Department of Cardiology, Universitätsmedizin Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany.,Privatpraxis Dr. Kherad, Große Hamburger Straße 5-11, 10115, Berlin, Germany
| | - Clemens Köhncke
- Department of Cardiology, Universitätsmedizin Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany
| | - Frank Spillmann
- Department of Cardiology, Universitätsmedizin Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany
| | - Heiner Post
- Department of Cardiology, Universitätsmedizin Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany
| | - Michel Noutsias
- Department of Internal Medicine I, Division of Cardiology, Pneumology, Angiology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - Burkert Pieske
- Department of Cardiology, Universitätsmedizin Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany.,German Heart Center (Deutsches Herzzentrum Berlin, (DHZB)), Berlin, Germany.,Deutsches Zentrum für Herz Kreislaufforschung (DZHK) - Standort Berlin/Charité, Campus Rudolf Virchow, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Florian Krackhardt
- Department of Cardiology, Universitätsmedizin Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany
| | - Carsten Tschöpe
- Department of Cardiology, Universitätsmedizin Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany. .,Berlin Center for Regenerative Therapies (BCRT), Campus Virchow Klinikum (CVK), Berlin, Germany. .,Deutsches Zentrum für Herz Kreislaufforschung (DZHK) - Standort Berlin/Charité, Campus Rudolf Virchow, Augustenburger Platz 1, 13353, Berlin, Germany.
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15
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Sławek S, Araszkiewicz A, Gaczkowska A, Koszarska J, Celiński D, Grygier M, Lesiak M, Grajek S. Endomyocardial biopsy via the femoral access - still safe and valuable diagnostic tool. BMC Cardiovasc Disord 2016; 16:222. [PMID: 27846815 PMCID: PMC5111178 DOI: 10.1186/s12872-016-0406-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 11/08/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The endomyocardial biopsy has proven to be an integral diagnostic tool for surveillance of cardiac allograft rejection and identification of myocardial diseases. Nevertheless, this invasive procedure is not risk-free. This study focuses on the risk of complications and diagnostic performance of right ventricular endomyocardial biopsy (EMB). METHODS In this single-center retrospective study, we analyzed 315 EMB procedures performed between July 2008 and May 2015 in 73 patients. All EMBs were made via the right femoral vein approach under fluoroscopic control to evaluate suspected myocarditis, unclear heart failure, unexplained cardiomyopathy, assumed infiltrative and storage disease or as a part of routine allograft rejection monitoring and clinically suspected rejection diagnosis after heart transplantation (HTx). Obtained specimens were diagnosed histopathologically by one experienced pathologist. All patients underwent a 12-lead electrocardiogram (ECG), ECG monitoring, transthoracic echocardiography before and after EMB to obtain a detailed assessment of the incidence of heart rhythm disorders, pericardial effusions or worsening valve insufficiency. Complications resulting from the procedure were classified as major or minor according to the risk of death. RESULTS Among all the 315 biopsies, 86.67% were performed in 32 patients after HTx, 3.81% in patients with myocarditis, 2.54% in patients with dilated cardiomyopathy and 1.9% in patients with amyloidosis. The overall complications rate was 1.9% (6 of 315 procedures). Major complications included perforation with pericardial tamponade requiring surgical intervention (0.64%, 2 of 315 procedures). Minor complications included: pericardial effusion (0.32%, 1 of 315 procedures), local hematoma (0.64%, 2 of 315 procedures) and right coronary artery-right ventricle fistula in HTx recipient (0.32%, 1 of 315 procedures). CONCLUSIONS EMB is a safe procedure with low risk of serious complications and high effectiveness for the evaluation of unexplained left ventricle dysfunction and monitoring allograft rejection after HTx.
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Affiliation(s)
- Sylwia Sławek
- Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland.
| | | | | | - Justyna Koszarska
- Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Damian Celiński
- Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Marek Grygier
- Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Maciej Lesiak
- Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Stefan Grajek
- Department of Cardiology, Poznan University of Medical Sciences, Poznan, Poland
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16
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Toscano G, Gambino A, Bagozzi L, Guariento A, D'Amico G, Fedrigo M, Gerosa G. Endomyocardial biopsy under echocardiographic monitoring. Multimed Man Cardiothorac Surg 2016; 2016:mmw006. [PMID: 27247327 DOI: 10.1093/mmcts/mmw006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 02/19/2016] [Indexed: 06/05/2023]
Abstract
Endomyocardial biopsy is a common procedure for monitoring cardiac allograft rejection; several techniques have been described so far, throughout different access sites and under echocardiographic or X-ray control. We describe the routine technique adopted at our centre based on echo-guided puncture of jugular vein and echocardiographic assessment of endomyocardial sampling with direct visualization of the bioptome tip. We also report the most common complications of the procedure, especially concerning the risk of iatrogenic tricuspid regurgitation, and same examples of histopathological findings drawn from our own iconographic collection.
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Affiliation(s)
- Giuseppe Toscano
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Antonio Gambino
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Lorenzo Bagozzi
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Alvise Guariento
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Gianpiero D'Amico
- Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Marny Fedrigo
- Division of Cardiovascular Pathology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
| | - Gino Gerosa
- Division of Cardiac Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padova, Italy
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