Dec G W, Fallon J T, Southern J F, Palacios I
Medical Service, Massachusetts General Hospital, Boston 02114.
J Am Coll Cardiol. 1990 Feb;15(2):283-9. doi: 10.1016/s0735-1097(10)80050-6.
Repeat endomyocardial biopsy was performed in 28 patients with dilated cardiomyopathy of less than or equal to 12 months' duration and either symptomatic heart failure or life-threatening ventricular arrhythmias. Myocarditis was strongly suspected clinically in all cases, yet was unconfirmed on initial right ventricular biopsy. Seventeen patients underwent both right and left ventricular biopsy, seven patients had a repeat right ventricular biopsy and four patients underwent repeat left ventricular biopsy alone. The interval between initial and repeat biopsy averaged 31 +/- 6 days. Myocarditis was confirmed on repeat biopsy in 4 of 6 patients whose initial biopsy revealed "borderline" myocarditis (that is, interstitial inflammation but absence of myocyte necrosis) compared with none of the 22 patients whose initial biopsy showed either myocyte hypertrophy or interstitial fibrosis, or both (p = 0.0007). "Borderline" myocarditis on initial biopsy was the only clinical or histologic finding predictive of myocarditis on subsequent biopsy. Repeat endomyocardial biopsy can identify and potentially modify the treatment of an additional group of patients with dilated cardiomyopathy and nondiagnostic initial endomyocardial histologic features. Right ventricular sampling should be repeated in patients whose initial biopsy demonstrates "borderline" myocarditis.
对28例病程小于或等于12个月、伴有症状性心力衰竭或危及生命的室性心律失常的扩张型心肌病患者进行了重复心内膜心肌活检。所有病例临床均高度怀疑心肌炎，但初次右心室活检未得到证实。17例患者接受了右心室和左心室活检，7例患者进行了重复右心室活检，4例患者仅接受了重复左心室活检。初次活检与重复活检的间隔平均为31±6天。初次活检显示“临界性”心肌炎（即间质炎症但无心肌细胞坏死）的6例患者中，4例在重复活检时确诊为心肌炎，而初次活检显示心肌细胞肥大或间质纤维化或两者皆有的22例患者中无一例确诊（p = 0.0007）。初次活检时的“临界性”心肌炎是后续活检时心肌炎的唯一临床或组织学预测指标。重复心内膜心肌活检可识别并可能改变另一组扩张型心肌病且初次心内膜组织学特征未明确诊断患者的治疗方案。初次活检显示“临界性”心肌炎的患者应重复进行右心室取材。
