Tschöpe Carsten, Nelki Vivian, Trippel Tobias Daniel, Klingel Karin, Abawi Dawud, Alogna Alessio
Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité - University Medicine Berlin, Campus Virchow Clinic, Augustenburgerplatz 1, 13353 Berlin, Germany; Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburgerplatz 1, 13353 Berlin, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany.
Department of Internal Medicine and Cardiology, Charité - Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburgerplatz 1, 13353 Berlin, Germany.
Int J Cardiol. 2022 Dec 1;368:49-52. doi: 10.1016/j.ijcard.2022.08.010. Epub 2022 Aug 6.
In patients with de novo acute heart failure (AHF) requiring veno-arterial extracorporeal membrane oxygenation (VA-ECMO), endomyocardial biopsy (EMB) has been recently shown to be feasible and a helpful method to clarify differential diagnoses, including acute myocarditis. This study aimed to evaluate the feasibility and safety of EMB in patients with a left ventricular (LV) implanted Impella® device.
This retrospective, single-center study involves 22 cardiogenic shock patients [SCAI shock stage: C (91%)] requiring mechanical circulatory support (MCS) either by Impella® axial pumps [20 patients (91%)] alone or in combination with VA-ECMO [2 patients (9%)] between December 2017 and January 2022. Coronary artery disease (CAD) or severe valvular heart disease were excluded. The study's primary endpoint was to verify the safety of EMB during MCS. Furthermore, histopathological analysis of the EMB samples was described. 30 LV-EMB procedures were performed. No major complications were reported (death, sustained ventricular tachycardia, need for cardiopulmonary resuscitation, cardiac tamponade, stroke, major bleeding). In 14 patients (64%), EMB-derived histology/immunohistology led to the definitive diagnosis of acute myocarditis.
EMB can be safely performed in patients suffering from cardiogenic shock requiring an Impella®-based MCS without the risk of major complications. In about 50% of the patients, relevant inflammatory heart disease could be detected, which required a change in treatment decisions.
在需要静脉-动脉体外膜肺氧合（VA-ECMO）的新发急性心力衰竭（AHF）患者中，最近研究表明心内膜心肌活检（EMB）是可行的，且有助于明确包括急性心肌炎在内的鉴别诊断。本研究旨在评估在植入左心室（LV）Impella®装置的患者中进行EMB的可行性和安全性。
这项回顾性单中心研究纳入了2017年12月至2022年1月期间22例需要机械循环支持（MCS）的心源性休克患者[SCAI休克分期：C期（91%）]，这些患者单独使用Impella®轴流泵[20例（91%）]或联合VA-ECMO[2例（9%）]。排除冠状动脉疾病（CAD）或严重瓣膜性心脏病。研究的主要终点是验证MCS期间EMB的安全性。此外，还描述了EMB样本的组织病理学分析。共进行了30例左心室EMB手术。未报告重大并发症（死亡、持续性室性心动过速、需要心肺复苏、心脏压塞、中风、大出血）。14例患者（64%）中，EMB获得的组织学/免疫组织学检查确诊为急性心肌炎。
对于需要基于Impella®的MCS的心源性休克患者，可以安全地进行EMB，且无重大并发症风险。在约50%的患者中，可以检测到相关的炎症性心脏病，这需要改变治疗决策。
