TY - JOUR
T1 - Endomyocardial biopsy
T2 - The forgotten piece in the arrhythmogenic cardiomyopathy puzzle
AU - Casella, Michela
AU - Bergonti, Marco
AU - Russo, Antonio Dello
AU - Maragna, Riccardo
AU - Gasperetti, Alessio
AU - Compagnucci, Paolo
AU - Catto, Valentina
AU - Trombara, Filippo
AU - Frappampina, Antonio
AU - Conte, Edoardo
AU - Fogante, Marco
AU - Sommariva, Elena
AU - Rizzo, Stefania
AU - De Gaspari, Monica
AU - Giovagnoni, Andrea
AU - Andreini, Daniele
AU - Pompilio, Giulio
AU - Di Biase, Luigi
AU - Natale, Andrea
AU - Basso, Cristina
AU - Tondo, Claudio
N1 - Publisher Copyright:
© 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2021/10
Y1 - 2021/10
N2 - BACKGROUND: Endomyocardial biopsy (EMB) is part of 2010 Task Force Criteria (TFC) for arrhythmogenic right ventricular cardiomyopathy (ARVC). However, its usage has been curtailed because of its low presumed diagnostic yield, and it is now a poorly used tool. This study aims to analyze the contribution of EMB to the final diagnosis of ARVC. METHODS AND RESULTS: We included 104 consecutive patients evaluated for a suspicion of ARVC, who were referred for EMB. Patients with suspected left dominant pattern were excluded from the primary analysis. Subjects were initially stratified ac-cording to TFC without considering EMB. After EMB, patients were reclassified accordingly, and the reclassification rate was calculated. EMB yielded a diagnostic finding in 92 patients (85.5%). After including EMB evaluation, 20 (43%) more patients “at risk” received a definite diagnosis of ARVC. Overall, 59 patients received a definite diagnosis of ARVC, 34% only after EMB. EMB appeared to be the better-performing exam with respect to the final diagnosis (β, 2.2; area uder the curve, 0.73; P<0.05). The reclassification improvement after EMB measured 28%. TFC score increased from 3.5±1.3 to 4.3±1.4 (P<0.001). Notably, active inflammation was present in 6 (10%) patients. Minor complications were reported in only 2% of the cohort. In patients with suspected left-dominant disease, conventional TFC performed poorly. CONCLUSIONS: Electroanatomic voltage mapping– guided EMB was safe and yielded an optimal diagnostic yield. It allowed up-grading of the diagnosis of nearly one-third of the patients considered “at risk.” Classical TFC without EMB performed poorly in patients with the left dominant form of ARVC.
AB - BACKGROUND: Endomyocardial biopsy (EMB) is part of 2010 Task Force Criteria (TFC) for arrhythmogenic right ventricular cardiomyopathy (ARVC). However, its usage has been curtailed because of its low presumed diagnostic yield, and it is now a poorly used tool. This study aims to analyze the contribution of EMB to the final diagnosis of ARVC. METHODS AND RESULTS: We included 104 consecutive patients evaluated for a suspicion of ARVC, who were referred for EMB. Patients with suspected left dominant pattern were excluded from the primary analysis. Subjects were initially stratified ac-cording to TFC without considering EMB. After EMB, patients were reclassified accordingly, and the reclassification rate was calculated. EMB yielded a diagnostic finding in 92 patients (85.5%). After including EMB evaluation, 20 (43%) more patients “at risk” received a definite diagnosis of ARVC. Overall, 59 patients received a definite diagnosis of ARVC, 34% only after EMB. EMB appeared to be the better-performing exam with respect to the final diagnosis (β, 2.2; area uder the curve, 0.73; P<0.05). The reclassification improvement after EMB measured 28%. TFC score increased from 3.5±1.3 to 4.3±1.4 (P<0.001). Notably, active inflammation was present in 6 (10%) patients. Minor complications were reported in only 2% of the cohort. In patients with suspected left-dominant disease, conventional TFC performed poorly. CONCLUSIONS: Electroanatomic voltage mapping– guided EMB was safe and yielded an optimal diagnostic yield. It allowed up-grading of the diagnosis of nearly one-third of the patients considered “at risk.” Classical TFC without EMB performed poorly in patients with the left dominant form of ARVC.
KW - Arrhythmogenic cardiomyopathy
KW - Cardiac magnetic resonance
KW - Electroanatomic mapping
KW - Endomyocardial biopsies
KW - Right ventricular arrhythmogenic cardiomyopathy
KW - Task force criteria
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U2 - 10.1161/JAHA.121.021370
DO - 10.1161/JAHA.121.021370
M3 - Article
C2 - 34569251
AN - SCOPUS:85117257098
SN - 2047-9980
VL - 10
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 19
M1 - e021370
ER -