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Caforio ALP, Kaski JP, Gimeno JR, Elliott PM, Laroche C, Tavazzi L, Tendera M, Fu M, Sala S, Seferovic PM, Heliö T, Calò L, Blagova O, Amin A, Kindermann I, Sinagra G, Frustaci A, Bonnet D, Charron P, Maggioni AP. Endomyocardial biopsy: safety and prognostic utility in paediatric and adult myocarditis in the European Society of Cardiology EURObservational Research Programme Cardiomyopathy and Myocarditis Long-Term Registry. Eur Heart J 2024:ehae169. [PMID: 38594778 DOI: 10.1093/eurheartj/ehae169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 01/19/2024] [Accepted: 02/27/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND AND AIMS Contemporary multicentre data on clinical and diagnostic spectrum and outcome in myocarditis are limited. Study aims were to describe baseline features, 1-year follow-up, and baseline predictors of outcome in clinically suspected or biopsy-proven myocarditis (2013 European Society of Cardiology criteria) in adult and paediatric patients from the EURObservational Research Programme Cardiomyopathy and Myocarditis Long-Term Registry. METHODS Five hundred eighty-one (68.0% male) patients, 493 adults, median age 38 (27-52) years, and 88 children, aged 8 (3-13) years, were divided into 3 groups: Group 1 (n = 233), clinically suspected myocarditis with abnormal cardiac magnetic resonance; Group 2 (n = 222), biopsy-proven myocarditis; and Group 3 (n = 126) clinically suspected myocarditis with normal or inconclusive or no cardiac magnetic resonance. Baseline features were analysed overall, in adults vs. children, and among groups. One-year outcome events included death/heart transplantation, ventricular assist device (VAD) or implantable cardioverter defibrillator (ICD) implantation, and hospitalization for cardiac causes. RESULTS Endomyocardial biopsy, mainly right ventricular, had a similarly low complication rate in children and adults (4.7% vs. 4.9%, P = NS), with no procedure-related death. A classical myocarditis pattern on cardiac magnetic resonance was found in 31.3% of children and in 57.9% of adults with biopsy-proven myocarditis (P < .001). At 1-year follow-up, 11/410 patients (2.7%) died, 7 (1.7%) received a heart transplant, 3 underwent VAD (0.7%), and 16 (3.9%) underwent ICD implantation. Independent predictors at diagnosis of death or heart transplantation or hospitalization or VAD implantation or ICD implantation at 1-year follow-up were lower left ventricular ejection fraction and the need for immunosuppressants for new myocarditis diagnosis refractory to non-aetiology-driven therapy. CONCLUSIONS Endomyocardial biopsy was safe, and cardiac magnetic resonance using Lake Louise criteria was less sensitive, particularly in children. Virus-negative lymphocytic myocarditis was predominant both in children and adults, and use of immunosuppressive treatments was low. Lower left ventricular ejection fraction and the need for immunosuppressants at diagnosis were independent predictors of unfavourable outcome events at 1 year.
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Affiliation(s)
- Alida L P Caforio
- Cardiology, Department of Cardiological, Thoracic and Vascular Sciences and Public Health, University of Padova, Via N Giustiniani, 2, Padova 35100, Italy
| | - Juan P Kaski
- Cardiology, University College London and Great Ormond Street Hospital for Children, London, UK
| | - Juan R Gimeno
- Cardiac Department, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Perry M Elliott
- Institute of Cardiovascular Science, University College London and St. Bartholomew's Hospital, London, UK
| | - Cecile Laroche
- European Society of Cardiology, EURObservational Research Programme, Biot, France
| | - Luigi Tavazzi
- GVM Care& Research, Maria Cecilia Hospital, Cotignola, Italy
| | - Michal Tendera
- Department of Cardiology and Structural Heart Disease, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland
| | - Michael Fu
- Section of Cardiology, Department of Medicine, Sahlgrenska University Hospital/Östra Hospital, Gothenburg University, Gothenburg, Sweden
| | - Simone Sala
- Myocarditis Unit, Department of Cardiac Electrophysiology and Arrhythmology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Petar M Seferovic
- Serbian Academy of Sciences and Arts, Heart Failure Center, Faculty of Medicine, Belgrade University Medical Center, Belgrade, Serbia
| | - Tiina Heliö
- Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Leonardo Calò
- Department of Cardiology, Policlinico Casilino, Roma, Italy
| | - Olga Blagova
- V.N. Vinogradov Faculty Therapeutic Clinic, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russian Federation
| | - Ahmad Amin
- Department of Heart Failure and Transplantation, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Ingrid Kindermann
- Department of Internal Medicine III (Cardiology, Angiology and Intensive Care), Saarland University Medical Center, Saarland University, Homburg/Saar, Germany
| | | | | | - Daniel Bonnet
- M3C-Necker Enfants Malades, AP-HP, Université de Paris Cité, Paris, France
| | - Philippe Charron
- Sorbonne Université, Centre de Référence des Maladies Cardiaques Héréditaires ou Rares, Assistance Publique-Hôpitaux de Paris, ICAN, Inserm UMR1166, Hôpital Pitié-Salpêtrière, Paris, France
| | - Aldo P Maggioni
- European Society of Cardiology, EURObservational Research Programme, Biot, France
- ANMCO Research Center, Florence, Italy
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Roosens B, Cosyns B, Lancellotti P, Laroche C, Selton-Suty C, Pasquet A, De Sutter J, Unger P, Paelinck B, Vermeersch P, Motoc A, Galloo X, Iung B, Habib G. Infective Endocarditis in Belgium: Prospective Data in Adults from the ESC EORP European Endocarditis Registry. J Clin Med 2024; 13:1371. [PMID: 38592201 PMCID: PMC10932099 DOI: 10.3390/jcm13051371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 02/04/2024] [Accepted: 02/26/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: infective endocarditis (IE) is a significant health concern associated with important morbidity and mortality. Only limited, often monocentric, retrospective data on IE in Belgium are available. This prospective study sought to assess the clinical characteristics and outcomes of Belgian IE patients in the ESC EORP European endocarditis (EURO-ENDO) registry; (2) Methods: 132 IE patients were identified based on the ESC 2015 criteria and included in six tertiary hospitals in Belgium; (3) Results: The average Belgian IE patient was male and 62.8 ± 14.9 years old. The native valve was most affected (56.8%), but prosthetic/repaired valves (34.1%) and intracardiac device-related (5.3%) IE are increasing. The most frequently identified microorganisms were S. aureus (37.2%), enterococci (15.5%), and S. viridans (15.5%). The most frequent complications were acute renal failure (36.2%) and embolic events (23.6%). Cardiac surgery was effectively performed when indicated in 71.7% of the cases. In-hospital mortality occurred in 15.7% of patients. Predictors of mortality in the multivariate analysis were S. aureus (HR = 2.99 [1.07-8.33], p = 0.036) and unperformed cardiac surgery when indicated (HR = 19.54 [1.91-200.17], p = 0.012). (4) Conclusion: This prospective EURO-ENDO ancillary analysis provides valuable contemporary insights into the profile, treatment, and clinical outcomes of IE patients in Belgium.
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Affiliation(s)
- Bram Roosens
- Centrum voor Hart-en Vaatziekten (CHVZ), Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), 1090 Brussels, Belgium (P.U.); (B.P.); (P.V.); (X.G.)
| | - Bernard Cosyns
- Centrum voor Hart-en Vaatziekten (CHVZ), Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), 1090 Brussels, Belgium (P.U.); (B.P.); (P.V.); (X.G.)
| | - Patrizio Lancellotti
- Department of Cardiology, Centre Hospitalier Universitaire Sart Tilman, 4000 Liège, Belgium;
| | - Cécile Laroche
- EURObservational Research Programme, European Society of Cardiology, 06903 Biot, France (C.S.-S.)
| | - Christine Selton-Suty
- EURObservational Research Programme, European Society of Cardiology, 06903 Biot, France (C.S.-S.)
- Department of Cardiology, Centre Hospitalier Universitaire de Nancy, 54000 Nancy, France
| | - Agnès Pasquet
- Divisions of Cardiology and Cardiothoracic Surgery, Cliniques Universitaires Saint-Luc, 1200 Brussels, Belgium;
| | - Johan De Sutter
- Hartcentrum Gent, Algemeen Ziekenhuis Maria Middelares, 9000 Ghent, Belgium
| | - Philippe Unger
- Centrum voor Hart-en Vaatziekten (CHVZ), Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), 1090 Brussels, Belgium (P.U.); (B.P.); (P.V.); (X.G.)
- Department of Cardiology, Centre Hospitalier Universitaire Saint-Pierre, 1000 Brussels, Belgium
| | - Bernard Paelinck
- Centrum voor Hart-en Vaatziekten (CHVZ), Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), 1090 Brussels, Belgium (P.U.); (B.P.); (P.V.); (X.G.)
- Department of Cardiology, Universitair Ziekenhuis (UZ) Antwerpen, 2650 Antwerp, Belgium
| | - Paul Vermeersch
- Centrum voor Hart-en Vaatziekten (CHVZ), Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), 1090 Brussels, Belgium (P.U.); (B.P.); (P.V.); (X.G.)
- Hartcentrum, Ziekenhuis Netwerk Antwerpen (ZNA), 2020 Antwerp, Belgium
| | - Andreea Motoc
- Centrum voor Hart-en Vaatziekten (CHVZ), Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), 1090 Brussels, Belgium (P.U.); (B.P.); (P.V.); (X.G.)
| | - Xavier Galloo
- Centrum voor Hart-en Vaatziekten (CHVZ), Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), 1090 Brussels, Belgium (P.U.); (B.P.); (P.V.); (X.G.)
| | - Bernard Iung
- Department of Cardiology, Bichat Hospital, APHP, Université Paris-Cité, 75018 Paris, France;
| | - Gilbert Habib
- APHM, La Timone Hospital, Cardiology Department, Marseille, France & Aix Marseille University, IRD, APHM, MEPHI, IHU-Mediterranean Infection, 13005 Marseille, France
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Neglia D, Liga R, Gimelli A, Podlesnikar T, Cvijić M, Pontone G, Miglioranza MH, Guaricci AI, Seitun S, Clemente A, Sumin A, Vitola J, Saraste A, Paunonen C, Sia CH, Paleev F, Sade LE, Zamorano JL, Maroz-Vadalazhskaya N, Anagnostopoulos C, Macedo F, Knuuti J, Edvardsen T, Cosyns B, Petersen SE, Magne J, Laroche C, Berlè C, Popescu BA, Delgado V. Use of cardiac imaging in chronic coronary syndromes: the EURECA Imaging registry. Eur Heart J 2023; 44:142-158. [PMID: 36452988 DOI: 10.1093/eurheartj/ehac640] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 09/20/2022] [Accepted: 10/26/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND The prospective, multicentre EURECA registry assessed the use of imaging and adoption of the European Society of Cardiology (ESC) Guidelines (GL) in patients with chronic coronary syndromes (CCS). METHODS Between May 2019 and March 2020, 5156 patients were recruited in 73 centres from 24 ESC member countries. The adoption of GL recommendations was evaluated according to clinical presentation and pre-test probability (PTP) of obstructive coronary artery disease (CAD). RESULTS The mean age of the population was 64 ± 11 years, 60% of patients were males, 42% had PTP >15%, 27% had previous CAD, and ejection fraction was <50% in 5%. Exercise ECG was performed in 32% of patients, stress imaging as the first choice in 40%, and computed tomography coronary angiography (CTCA) in 22%. Invasive coronary angiography (ICA) was the first or downstream test in 17% and 11%, respectively. Obstructive CAD was documented in 24% of patients, inducible ischaemia in 19%, and 13% of patients underwent revascularization. In 44% of patients, the overall diagnostic process did not adopt the GL. In these patients, referral to stress imaging (21% vs. 58%; P < 0.001) or CTCA (17% vs. 30%; P < 0.001) was less frequent, while exercise ECG (43% vs. 22%; P < 0.001) and ICA (48% vs. 15%; P < 0.001) were more frequently performed. The adoption of GL was associated with fewer ICA, higher proportion of diagnosis of obstructive CAD (60% vs. 39%, P < 0.001) and revascularization (54% vs. 37%, P < 0.001), higher quality of life, fewer additional testing, and longer times to late revascularization. CONCLUSIONS In patients with CCS, current clinical practice does not adopt GL recommendations on the use of diagnostic tests in a significant proportion of patients. When the diagnostic approach adopts GL recommendations, invasive procedures are less frequently used and the diagnostic yield and therapeutic utility are superior.
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Affiliation(s)
- Danilo Neglia
- Cardiovascular and Imaging Departments, Fondazione Toscana G. Monasterio, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy
- Sant'Anna School of Advanced Studies, Piazza Martiri della Libertà, 33, 56127 Pisa, Italy
| | - Riccardo Liga
- Dipartimento di Patologia Chirurgica, Medica, Molecolare e dell' Area Critica, University of Pisa, Via Savi 10, 56126 Pisa, Italy
- Dipartimento Cardiotoraco Vascolare, Azienda Ospedaliero-Universitaria Pisana, Via Paradisa, 2, 56124 Pisa, Italy
| | - Alessia Gimelli
- Cardiovascular and Imaging Departments, Fondazione Toscana G. Monasterio, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy
| | - Tomaž Podlesnikar
- Department of Cardiology, University Medical Centre Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia
- Department of Cardiac Surgery, University Medical Centre Maribor, Ljubljanska ulica 5, 2000 Maribor, Slovenia
| | - Marta Cvijić
- Department of Cardiology, University Medical Centre Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, Via Carlo Parea, 4, 20138 Milano, Italy
| | - Marcelo Haertel Miglioranza
- EcoHaertel-Mae de Deus Hospital, R. José de Alencar, 286 - Menino Deus, Porto Alegre - RS, 90880-481, Brazil
- Federal University of Health Sciences of Porto Alegre (UFCSPA), R. Sarmento Leite, 245 - Centro Histórico, Porto Alegre - RS, 90050-17, Brazil
- Institute of Cardiology-University Foundation of Cardiology, R. Sarmento Leite, 245 - Centro Histórico, Porto Alegre - RS, 90050-170, Brazil
| | - Andrea Igoren Guaricci
- Department of Emergency and Organ Transplantation, Institute of Cardiovascular Disease, University Hospital 'Policlinico' of Bari, Piazza Giulio Cesare, 11, 70124 Bari, Italy
| | - Sara Seitun
- Department of Radiology, IRCCS Policlinico San Martino Hospital, Largo Rosanna Benzi, 10, 16132 Genova, Italy
| | - Alberto Clemente
- Cardiovascular and Imaging Departments, Fondazione Toscana G. Monasterio, Via Giuseppe Moruzzi, 1, 56124 Pisa, Italy
| | - Alexey Sumin
- Federal State Budgetary Scientific Institution "Research Institute for Complex Issues of Cardiovascular Diseases", Sosnoviy Blvd., 6, 650002 Kemerovo, Russian Federation
| | - João Vitola
- Quanta Diagnostico por Imagem, R. Alm. Tamandaré, 1000 - Alto da XV, Curitiba - PR, 80045-170, Brazil
| | - Antti Saraste
- Heart Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20521 Turku, Finland
| | - Christian Paunonen
- Heart Centre, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8, 20521 Turku, Finland
| | - Ching-Hui Sia
- National University Heart Centre Singapore, 5 Lower Kent Ridge Rd, 119074 Singapore, Singapore
| | - Filipp Paleev
- National Medical Research Center of Cardiology, 3-Ya Cherepkovskaya Ulitsa, 15A, 121552 Moscow, Russian Federation
| | - Leyla Elif Sade
- Department of Cardiology, University of Baskent, Yukarı Bahçelievler, Mareşal Fevzi Çakmak Cd. No: 45, 06490 Çankaya/Ankara, Turkey
| | - Jose Luis Zamorano
- Department of Cardiology, Ramon Y Cajal University Hospital, M-607, 9, 100, 28034 Madrid, Spain
| | - Natallia Maroz-Vadalazhskaya
- Department of General Practice, Division of Postgraduate Education, Belarusian State Medical University, Dzerzhinski Ave 83, 220083 Minsk, Belarus
| | - Constantinos Anagnostopoulos
- PET-CT Department & Preclinical Imaging Unit, Centre for Experimental Surgery, Clinical and Translational Research, Biomedical Research Foundation Academy of Athens, 4 Soranou Ephessiou Street, 115 27 Athens, Greece
| | - Filipe Macedo
- Cardiology Department, S João University Hospital, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Juhani Knuuti
- Turku PET Centre, Turku University Hospital and University of Turku, c/o Turku University Hospital, Kiinamyllynkatu 4-8, 20520 Turku, Finland
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Kirkeveien 166, 0450 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Klaus Torgårds vei 3, 0372 Oslo, Norway
| | - Bernard Cosyns
- Centrum voor Hart en Vaatziekten, Universtair Ziekenhuis Brussel, Av. du Laerbeek 101, 1090 Bruxelles, Belgium
- In Vivo Molecular and Cellular Imaging Center, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Jette, Belgium
| | - Steffen E Petersen
- Barts Heart Center, St. Bartholomew's Hospital, West Smithfield, W Smithfield, London EC1A 7BE, UK
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK
| | - Julien Magne
- Inserm Unit 1094 and IRD, Faculty of Medicine, Limoges University, 2 rue du Dr Marcland, 87025 Limoges, France
- Centre of Epidemiology, Biostatistic and Methodology of Research, University Hospital, Limoges, 2 Av. Martin Luther King, 87000 Limoges, France
- Department of Cardiology, Dupuytren-2 University Hospital, 16 rue Bernard Descottes, 87042 Limoges, France
| | - Cecile Laroche
- The European Society of Cardiology, The European Heart House, Sophia Antipolis Cedex, 2035 Rte des Colles, 06410 Biot, France
| | - Clara Berlè
- The European Society of Cardiology, The European Heart House, Sophia Antipolis Cedex, 2035 Rte des Colles, 06410 Biot, France
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy 'Carol Davila', Euroecolab, Emergency Institute for Cardiovascular Diseases 'Prof. Dr. C. C. Iliescu', Bulevardul Eroii Sanitari 8, 050474 București, Romania
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
- Heart Institute, Hospital University Germans Trias i Pujol, Carretera de Canyet, s/n, 08916, Badalona, Barcelona, Spain
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