Tebbe Ulrich, Bramlage Karin, John Fiete, Härtel Dirk, Felgendreher Ralf, Machalke Kathrin, Kandolf Reinhard, Bramlage Peter
Clinic for Cardiology, Angiology and Internal Intensive Medicine, Herz-Kreislauf-Zentrum, Klinikum Lippe, Detmold, Germany.
Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany.
BMC Res Notes. 2016 Oct 10;9(1):459. doi: 10.1186/s13104-016-2263-4.
In patients with cardiomyopathy of unknown origin, endomyocardial biopsy provides the possibility of improved diagnosis and tailored treatment. Specific guidance has been developed based on cardiovascular centre of excellence experience but it is unknown if the benefits also extend into the tertiary care hospital setting.
Endomyocardial biopsies was performed in patients with cardiomyopathy of unknown origin. The outcomes were mirrored against the current ESC recommendations.
A total of 57 patients with cardiomyopathy of unknown origin underwent endomyocardial biopsy with a mean age of 54 years and 28 % being women. In 17 patients (30 %), viruses were detected in the biopsy material, in 6 patients (11 %) cardiac amyloidosis was found of which 3 had also a positive test for viruses. The overall mortality rate was 18 % in the mean follow up period of 30 months, with a rate of 24 % in those with virus detection (mean FU 24 months) and 15 % in those without virus detection (mean FU 31 months. Death rates were 83 % in patients with cardiac amyloidosis (mean FU 10 months).
We conclude that, limited by uncertainty stemming from the small number of included patients, endomyocardial biopsy may not prove to have a clinical impact on treatment decisions and outcomes in a tertiary care hospital setting. We consider cardiac amyloidosis to be an exception, since the mortality rate with or without concomitant virus load was extremely high.
对于病因不明的心肌病患者，心内膜心肌活检为改善诊断和进行个体化治疗提供了可能。基于卓越心血管中心的经验已制定了具体指南，但尚不清楚这些益处是否也适用于三级医院环境。
对病因不明的心肌病患者进行心内膜心肌活检。将结果与当前欧洲心脏病学会（ESC）的建议进行对照。
共有57例病因不明的心肌病患者接受了心内膜心肌活检，平均年龄54岁，女性占28%。在17例患者（30%）的活检材料中检测到病毒，6例患者（11%）发现心脏淀粉样变性，其中3例病毒检测也呈阳性。在平均30个月的随访期内，总死亡率为18%，病毒检测阳性患者的死亡率为24%（平均随访24个月），未检测到病毒患者的死亡率为15%（平均随访31个月）。心脏淀粉样变性患者的死亡率为83%（平均随访10个月）。
我们得出结论，由于纳入患者数量较少导致存在不确定性，心内膜心肌活检可能对三级医院环境中的治疗决策和结果没有临床影响。我们认为心脏淀粉样变性是个例外，因为无论是否伴有病毒载量，其死亡率都极高。
