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
Alida L.P. Caforio(University of Padua), Juan Pablo Kaski(Great Ormond Street Hospital), Juan R. Gimeno(Hospital Universitario Virgen de la Arrixaca), Perry Elliott(St Bartholomew's Hospital), Cécile Laroche(European Society of Cardiology), Luigi Tavazzi(Maria Cecilia Hospital), Michał Tendera(Medical University of Silesia), Michael Fu(Sahlgrenska University Hospital), Simone Sala(Vita-Salute San Raffaele University), Petar Seferović(Serbian Academy of Sciences and Arts), Tiina Heliö(University of Helsinki), Leonardo Calò(Policlinico Casilino), О. В. Благова(Sechenov University), Ahmad Amin(Iran University of Medical Sciences), Ingrid Kindermann(Saarland University), Gianfranco Sinagra(University of Trieste), Andrea Frustaci(IRCCS Ospedale San Raffaele), D Bonnet(Université Paris Cité), Philippe Charron(Inserm), Aldo P Maggioni(European Society of Cardiology), CMY Registry Investigators(Inserm), Roberto Ferrari, Alvaro Alonso(Hospital Universitario Virgen de la Arrixaca), Jeroen J. Bax(Inserm), Carina Blomström‐Lundqvist(IRCCS Ospedale San Raffaele), Stephan Gielen(Inserm), Patrizio Lancellotti(European Society of Cardiology), Aldo P. Maggioni(European Society of Cardiology), Nikos Maniadakis(IRCCS Ospedale San Raffaele), Fausto J. Pinto(IRCCS Ospedale San Raffaele), Frank Ruschitzka(Maria Cecilia Hospital), Luigi Tavazzi(Inserm), Panos Vardas(IRCCS Ospedale San Raffaele), F Weidinger(IRCCS Ospedale San Raffaele), Uwe Zeymer, Alec Vahanian, A Budaj(European Society of Cardiology), N Dagres(European Society of Cardiology), Nicolas Danchin(Sechenov University), Victoria Delgado(Hospital Universitario Virgen de la Arrixaca), J Emberson(European Society of Cardiology), Örjan Friberg, Chris P Gale(European Society of Cardiology), Gr. Heyndrickx(Université Paris Cité), Bernard Iung(IRCCS Ospedale San Raffaele), Stefan James(Inserm), A. Pieter Kappetein(European Society of Cardiology), Aldo P. Maggioni(European Society of Cardiology), Nikos Maniadakis, Klaudia Vivien Nagy(European Society of Cardiology), G Parati(Great Ormond Street Hospital), A-S Petronio(European Society of Cardiology), Mikko Pietilä(Inserm), Eva Prescott(IRCCS Ospedale San Raffaele), Frank Ruschitzka(IRCCS Ospedale San Raffaele), Frans Van de Werf(IRCCS Ospedale San Raffaele), F Weidinger(IRCCS Ospedale San Raffaele), U Zeymer, Chris P Gale(Université Paris Cité), B. Beleslin, A Budaj(European Society of Cardiology), Ovidiu Chioncel(European Society of Cardiology), N Dagres(European Society of Cardiology), Nicolas Danchin(Hospital Universitario Virgen de la Arrixaca), J Emberson(European Society of Cardiology), David Erlinge(European Society of Cardiology), Michael Glikson, Alastair Gray(European Society of Cardiology), M Kayikcioglu(European Society of Cardiology), Aldo P. Maggioni(European Society of Cardiology), K V Nagy, А. О. Недошивин, A-P Petronio, Jolien W. Roos‐Hesselink(European Society of Cardiology), Lars Wallentin(IRCCS Ospedale San Raffaele), U Zeymer(Université Paris Cité), B A Popescu(European Society of Cardiology), David Adlam(University of Padua), Alida L.P. Caforio(University of Padua), Davide Capodanno(European Society of Cardiology), Marc R. Dweck(European Society of Cardiology), David Erlinge(European Society of Cardiology), Michael Glikson(Hospital Universitario Virgen de la Arrixaca), Jörg Hausleiter(Université Paris Cité), Bernard Iung(European Society of Cardiology), M Kayikcioglu(Inserm), Peter Ludman(European Society of Cardiology), Lars H. Lund(European Society of Cardiology), Aldo P. Maggioni(European Society of Cardiology), С.Т. Мацкеплишвили(Université Paris Cité), Benjamin Meder, K V Nagy, А. О. Недошивин(European Society of Cardiology), Danilo Neglia, Agnès Pasquet, Jolien W. Roos‐Hesselink, Fernando J. Rossello, Sameh Shaheen, Aleksandra Torbica(University of Padua), Alida L.P. Caforio(University of Padua), Juan R. Gimeno(Inserm), Philippe Charron(St Bartholomew's Hospital), Perry Elliott(St Bartholomew's Hospital), Juan Pablo Kaski(Great Ormond Street Hospital), Aldo P Maggioni(European Society of Cardiology), Luigi Tavazzi(Medical University of Silesia), Michał Tendera(Medical University of Silesia), Jaana Pihkala(Université Paris Cité), Tiina Ojala, Anita Hiippala(Université Paris Cité), Teppo L. N. Järvinen(Hospital Universitario Virgen de la Arrixaca), Jyri Lommi(University of Helsinki), Tiina Heliö(University of Helsinki), Juha Sinisalo(Université Paris Cité), Damien Bonnet(Université Paris Cité), Diala Khraiche(European Society of Cardiology), Isabelle Szézépanski(Inserm), Philippe Charron(Inserm), Stefan Mankikian(Inserm), Carole Maupain, J-P Collet(Inserm), Estelle Gandjbakhch(European Society of Cardiology), Mathieu Kernéis, J.F. Pruny, Anna Bauer(Université Paris Cité), Barbara Pfeiffer, S B Felix(European Society of Cardiology), Daniel Beug(European Society of Cardiology), Marcus Dörr(IRCCS Ospedale San Raffaele), S Kaczmarek(Saarland University), Kristin Lehnert(European Society of Cardiology), A. K. Pedersen(European Society of Cardiology), Michael Bruder(European Society of Cardiology), Matthias Gorenflo(Inserm), Richard Arnold(IRCCS Ospedale San Raffaele), Sebastian Uhl(Sechenov University), Victoria C. Ziesenitz, A. Jung(Inserm), E. Roesch(European Society of Cardiology), Michael Böhm(Saarland University), Ingrid Kindermann(St Bartholomew's Hospital), Yvonne Linicus(Inserm), Christian Werner(Université Paris Cité), B Neurath(European Society of Cardiology), M Schild-Ungerbuehler(Saarland University), Michael Kindermann(Great Ormond Street Hospital), Juan Pablo Kaski(Great Ormond Street Hospital), Gabrielle Norrish(Inserm), Ella Field(St Bartholomew's Hospital), Perry Elliott(St Bartholomew's Hospital), Massimiliano Lorenzini(European Society of Cardiology), Oliver Watkinson(Inserm), Eleanor Wicks, Aris Anastasakis(Saarland University), K Ritsatos(Sechenov University), V Vlagkouli(IRCCS Ospedale San Raffaele), S. Rammos(European Society of Cardiology), Georgios Kourelis, Anastasia Giannakopoulou(Inserm), Evangelos Karanasios(Inserm), Panagiotis Papachristou(European Society of Cardiology), G. Papadopoulos(European Society of Cardiology), George Servos(European Society of Cardiology), Majid Maleki(IRCCS Ospedale San Raffaele), F Noohi Bezanjani(Iran University of Medical Sciences), Ahmad Amin(Iran University of Medical Sciences), Nasim Naderi(European Society of Cardiology), Mozhgan Parsaee(IRCCS Ospedale San Raffaele), Sepideh Taghavi(Université Paris Cité), Behshid Ghadrdoost(IRCCS Ospedale San Raffaele), Sahar Jafari(European Society of Cardiology), Meysam Khoshavi(Inserm), Paolo Della Bella(Vita-Salute San Raffaele University), Simone Sala(Vita-Salute San Raffaele University), Giovanni Peretto(Inserm), Raffaele Calabrò(European Society of Cardiology), Giuseppe Pacileo, Maria Giovanna Russo(European Society of Cardiology), Giuseppe Limongelli, Augusto Esposito(IRCCS Ospedale San Raffaele), Felice Gragnano(Inserm), Rita Gravino(Université Paris Cité), Tommaso Marrazzo(European Society of Cardiology), Daniele Masarone(Sechenov University), Vittorio Pazzanese(European Society of Cardiology), Marta Rubino(IRCCS Ospedale San Raffaele), Stefania Tramonte(IRCCS Ospedale San Raffaele), Fabio Valente(European Society of Cardiology), Martina Caiazza(Inserm), Paolo Calabrò, Annapaola Cirillo(Université Paris Cité), Bruno Trimarco(European Society of Cardiology), M-A Losi(Inserm), Carlo Di Nardo, A Giamundo(IRCCS Ospedale San Raffaele), F Pacelli(European Society of Cardiology), Grazia Canciello(IRCCS Ospedale San Raffaele), Sabino Iliceto(University of Padua), Alida L.P. Caforio(University of Padua), Chiara Calore(European Society of Cardiology), Loira Leoni(European Society of Cardiology), Martina Perazzolo Marra(European Society of Cardiology), Ilaria Rigato(European Society of Cardiology), Giuseppe Tarantini, Alessandro Schiavo(European Society of Cardiology), Martina Testolina(IRCCS Ospedale San Raffaele), Francesco Fedele(IRCCS Ospedale San Raffaele), Andrea Frustaci(European Society of Cardiology), Maria Alfarano(Inserm), Cristina Chimenti(IRCCS Ospedale San Raffaele), Fabrizio Drago, Anwar Baban(Policlinico Casilino), Leonardo Calò(Inserm), Chiara Lanzillo, Annamaria Martino(European Society of Cardiology), Mariagrazia Uguccioni(Inserm), Elisabetta Zachara(European Society of Cardiology), Géza Hálasz(IRCCS Ospedale San Raffaele), Federica Re(University of Trieste), Gianfranco Sinagra(University of Trieste), Cosimo Carriere(European Society of Cardiology), Marco Merlo(IRCCS Ospedale San Raffaele), Federica Ramani, Aušra Kavoliūnienė, Aušra Krivickienė(Inserm), Eglė Tamulevičiūtė-Prascienė(European Society of Cardiology), Mindaugas Vieželis(Hospital Universitario Virgen de la Arrixaca), Jelena Čelutkienė(European Society of Cardiology), L Balkeviciene(European Society of Cardiology), Monika Laukytė(Inserm), Eglė Palevičiūtė(IRCCS Ospedale San Raffaele), Folkert W. Asselbergs(European Society of Cardiology), Nicolaas de Jonge, J. H. Kirkels(Hospital Universitario Virgen de la Arrixaca), Joris van der Heijden(European Society of Cardiology), L Van Laake, Arjan Sammani(Saarland University), Katarzyna Mizia‐Stec(Medical University of Silesia), Michał Tendera(Medical University of Silesia), Maciej Wybraniec, A Czekaj, A. Sikora-Puz, Anna Skoczyńska(Inserm), Paweł Rubiś(IRCCS Ospedale San Raffaele), S Wisniowska-Smialek(Hospital Universitario Virgen de la Arrixaca), Jacek Grzybowski(European Society of Cardiology), Natalia Ojrzyńska(Maria Cecilia Hospital), Zofia T. Bilińska(Inserm), Przemysław Chmielewski(Université Paris Cité), Bogna Foss-Nieradko(Inserm), Ewa Michalak(European Society of Cardiology), M Stepien-Wojno(Université Paris Cité), B Mazek(European Society of Cardiology), Grażyna Brzezińska‐Rajszys(European Society of Cardiology), Lidia Ziółkowska, Agnieszka Boruc(Inserm), E Plodzien(European Society of Cardiology), Luís R. Lopes(Inserm), A R Almeida(European Society of Cardiology), Inés Cruz(Inserm), Ana Catarina Gomes(Inserm), Ana Rita Pereira(Inserm), Carmen Ginghină(Inserm), Ruxandra Jurcuţ(Inserm), Eduard Apetrei(IRCCS Ospedale San Raffaele), Sebastian Militaru(European Society of Cardiology), Ioan Mircea Coman, A Mursa(Université Paris Cité), B A Popescu, Attila Frigy(European Society of Cardiology), Lajos Fehérvári(Maria Cecilia Hospital), Zoltán Fogarasi(European Society of Cardiology), Ildikó Kocsis(European Society of Cardiology), István Adorján Szabó(European Society of Cardiology), И. Г. Никитин(Inserm), Ernesto Resnik(European Society of Cardiology), Maria Komissarova(Sechenov University), V.B. Lazarev(European Society of Cardiology), M Shebzukhova(European Society of Cardiology), D. V. Ustyuzhanin(Sechenov University), О. В. Благова(Sechenov University), Irina B. Alieva(Sechenov University), V Kulikova(St Bartholomew's Hospital), Yu. A. Lutokhina(Inserm), E. V. Pavlenko(European Society of Cardiology), N. V. Varionchik(Inserm), E. V. Zaklyazminskaya(IRCCS Ospedale San Raffaele), Dzemeshkevich Sl(Inserm), Е. А. Колбасова(European Society of Cardiology), N.P. Kotlukova(Sechenov University), Valeria Rusinova(European Society of Cardiology), Arsen Ristić(Serbian Academy of Sciences and Arts), Petar Seferović(Serbian Academy of Sciences and Arts), Aleksandra Pavlović(European Society of Cardiology), Goran Radovanović(European Society of Cardiology), Dejan Simeunović(European Society of Cardiology), Ivana Živković(European Society of Cardiology), Ivan Milinković(IRCCS Ospedale San Raffaele), F Gran Ipina(IRCCS Ospedale San Raffaele), F Roses Noguer(European Society of Cardiology), D Albert Brotons, Ángel Cequier(Hospital Universitario Virgen de la Arrixaca), Joel Salazar‐Mendiguchía(Hospital Universitario Virgen de la Arrixaca), Joseph E. Gonzalez(European Society of Cardiology), Nicolás Manito(Inserm), Pablo García‐Pavía, Abelardo Morales Briceño(European Society of Cardiology), Marta Cobo Marcos(IRCCS Ospedale San Raffaele), Fernándo Domínguez, Juan Ramón Gimeno Blanes, F J Castro(Inserm), Carmen Muñoz Esparza(European Society of Cardiology), Marcos Molina(European Society of Cardiology), M Sorli García(European Society of Cardiology), David López Cuenca(Université Paris Cité), Tomás Ripoll‐Vera(Hospital Universitario Virgen de la Arrixaca), J. Álvarez(Hospital Universitario Virgen de la Arrixaca), J Nunez(St Bartholomew's Hospital), Y. Gómez, P L Sanchez Fernandez(Inserm), Eduardo Villacorta(Inserm), C Avila(European Society of Cardiology), Loreto Bravo(Inserm), Elena Díaz-Peláez(European Society of Cardiology), María Gallego‐Delgado(European Society of Cardiology), L Garcia-Cuenllas(Université Paris Cité), Beatriz Plata Izquierdo(Sahlgrenska University Hospital), Michael Fu(Sahlgrenska University Hospital), Uğur Canpolat
Cited by 29Open Access
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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