Department of Medicine, NYU Langone Health, New York, NY, USA; Department of Cardiovascular Disease, University of Minnesota Medical School, Minneapolis, MN, USA.
Department of Medicine, NYU Langone Health, New York, NY, USA.
Heart Lung Circ. 2022 Jun;31(6):815-821. doi: 10.1016/j.hlc.2021.12.014. Epub 2022 Feb 12.
Specific aetiologies of cardiomyopathy can significantly impact treatment options as well as appropriateness and prioritisation for advanced heart failure therapies such as ventricular assist device (VAD) or orthotopic heart transplantation (OHT). We reviewed the tissue diagnoses of patients who underwent advanced therapies for heart failure (HF) to identify diagnostic discrepancies.
This study presents a retrospective cohort of the aetiology of cardiomyopathy in 118 patients receiving either durable VAD or OHT. Discrepancies between the preoperative aetiological diagnosis of cardiomyopathy with the pathological diagnosis were recorded. Echocardiographic and haemodynamic data were reviewed to examine differences in patients with differing aetiological diagnoses.
Twelve (12) of 118 (12/118) (10.2%) had a pathological diagnosis that was discordant with pre-surgical diagnosis. The most common missed diagnoses were infiltrative cardiomyopathy (5) and hypertrophic cardiomyopathy (3). Patients with misidentified aetiology of cardiomyopathy had smaller left ventricular (LV) dimensions on echocardiography than patients with dilated cardiomyopathy (5.8±0.9 vs 6.7±1.1 respectively p=0.01).
Most HF patients undergoing VAD and OHT had a correct diagnosis for their heart failure prior to treatment, but a missed diagnosis at time of intervention (VAD or OHT) was not uncommon. Smaller LV dimension on echocardiogram in a patient with a non-ischaemic cardiomyopathy warrants further workup for a more specific aetiology.
心肌病的特定病因会显著影响治疗方案，以及心室辅助装置（VAD）或原位心脏移植（OHT）等晚期心力衰竭治疗的适宜性和优先级。我们回顾了接受晚期心力衰竭治疗的患者的组织诊断结果，以确定诊断差异。
本研究回顾性分析了 118 例接受耐用 VAD 或 OHT 的心肌病患者的病因。记录了术前心肌病病因诊断与病理诊断之间的差异。回顾了超声心动图和血流动力学数据，以检查不同病因诊断患者之间的差异。
118 例患者中有 12 例（12/118）（10.2%）的病理诊断与术前诊断不符。最常见的漏诊是浸润性心肌病（5 例）和肥厚型心肌病（3 例）。病因诊断错误的患者的左心室（LV）尺寸比扩张型心肌病患者小（分别为 5.8±0.9 和 6.7±1.1，p=0.01）。
大多数接受 VAD 和 OHT 的心力衰竭患者在治疗前对其心力衰竭有正确的诊断，但在干预（VAD 或 OHT）时漏诊并不少见。非缺血性心肌病患者超声心动图上的 LV 尺寸较小，应进一步检查以确定更具体的病因。
