Popma J J, Cigarroa R G, Buja L M, Hillis L D
Department of Internal Medicine (Cardiovascular Division) University of Texas Southwestern Medical Center, Dallas 75235.
Am J Cardiol. 1989 Apr 15;63(13):955-8. doi: 10.1016/0002-9149(89)90147-1.
To determine the value of cardiac catheterization and endomyocardial biopsy in patients with heart failure and dilated cardiomyopathy, the records of 61 patients (36 men, 25 women, ages 13 to 65 years) with this disorder were reviewed. Myocardial lymphocytic infiltration was present in 8 (13%). Three had myocyte degeneration and necrosis ("definite" myocarditis), whereas the other 5 had no degeneration or necrosis ("equivocal" myocarditis). Compared with the 53 without lymphocytic infiltration, these 8 patients more often had symptoms of a preceding viral illness (88 vs 30%, p = 0.002) and had a shorter duration of cardiac symptoms (18 +/- 18 vs 109 +/- 132 days [mean +/- standard deviation], p less than 0.001). Histologic features of the biopsy did not relate to survival, but right- and left-sided intracardiac pressures were higher (p less than 0.05) in nonsurvivors. Thus, (1) endomyocardial biopsy is most likely to show lymphocytic infiltration in patients with symptoms of a preceding viral illness and a short duration of cardiac symptoms, and (2) right- and left-sided hemodynamic variables at the time of biopsy may offer insight into prognosis.
为了确定心导管检查及心内膜心肌活检对心力衰竭和扩张型心肌病患者的价值，我们回顾了61例患有这种疾病的患者（36例男性，25例女性，年龄13至65岁）的记录。8例（13%）存在心肌淋巴细胞浸润。其中3例有心肌细胞变性和坏死（“确诊”心肌炎），而另外5例无变性或坏死（“可疑”心肌炎）。与53例无淋巴细胞浸润的患者相比，这8例患者更常出现前驱病毒感染症状（88%对30%，p = 0.002），且心脏症状持续时间较短（18±18天对109±132天[平均值±标准差]，p<0.001）。活检的组织学特征与生存率无关，但非存活者的左右心腔内压力较高（p<0.05）。因此，（1）心内膜心肌活检最有可能在有前驱病毒感染症状且心脏症状持续时间短的患者中显示淋巴细胞浸润，（2）活检时的左右血流动力学变量可能有助于了解预后。
