Potential of the Right Ventricular Endomyocardial Biopsy to Diagnose and Assist in the Management of Congestive Heart Failure: Insights From Recent Clinical Trials

Wu, Lambert A.; Cooper, Leslie T.

doi:10.1111/j.1527-5299.2004.03362.x

Cited by 8 publications

(8 citation statements)

References 48 publications

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“…uneinheitlichen Beurteilung der Endomyokardproben wurde durch die mehrfache Anpassung der Klassifikation [5] und die Konsensuskonferenzen zur Vereinheitlichung der diagnostischen Methoden Rechnung getragen [6,7], so dass sich heute wieder die Berichte zur Empfehlung der Entnahme von Endomyokardbiopsien auch aus dem amerikanischen Raum mehren [16,[21][22][23]. subjektiven bzw.…”

Section: Die Klassifikation Der Kardiomyopathien Der European Societyunclassified

Classification of Cardiomyopathies and Indication for Endomyocardial Biopsy Revisited

Pankuweit

Richter²,

Ruppert³

et al. 2009

Herz

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The first classifications of cardiomyopathies from 1980 and 1996 described them as heart muscle diseases, with dilated (DCM), hypertrophic (HCM), restrictive (RCM), arrhythmogenic right ventricular (ARVC), and nonclassifiable cardiomyopathies. Furthermore, the World Health Organization/International Society and Federation of Cardiology (WHO/ISFC) classification from 1996 listed among the specific cardiomyopathies inflammatory cardiomyopathy as a new and distinct entity, which was defined histologically as myocarditis in association with cardiac dysfunction. Infectious and autoimmune forms of inflammatory cardiomyopathy were recognized. Viral cardiomyopathy was defined as viral persistence in a dilated heart without ongoing inflammation. If it was accompanied by myocardial inflammation, it was termed inflammatory viral cardiomyopathy (or viral myocarditis with cardiomegaly). This entity was further elucidated in a World Heart Federation consensus meeting in 1999 by quantitative immunohistological criteria (< 14 infiltrating cells/mm(2)) and the etiology by molecular biological methods, e.g., polymerase chain reaction, as viral, bacterial, or autoimmune (= nonmicrobial). The development of molecular genetics, with the discovery of a genetic background in several forms of cardiomyopathies previously alluded to as "of unknown origin", was the origin of a debate on a new classification based on genomics. A genomic/postgenomic classification was postulated taking the underlying gene mutations and the cellular level of expression of encoded proteins into account, thus distinguishing cytoskeleton (cytoskeletalopathies, e.g., DCM or ARVC), sarcomeric (sarcomyopathies as in HCM and RCM) and ion channel (channelopathies, e.g., long or short QT syndrome and Brugada's syndrome) cardiomyopathies. Such a classification of cardiomyopathies was proposed in 2006 by the American Heart Association (AHA), which took the rapid evolution of molecular genetics in cardiology into account. It also introduced several recently described diseases, and is unique in that it incorporated ion channelopathies even without hemodynamic dysfunction as a "primary" cardiomyopathy. The ESC (European Society of Cardiology) Working Group on Myocardial and Pericardial Diseases has deliberately taken a different approach based on a clinically oriented classification in which heart muscle disorders were grouped according to morphology and function. This obviously remains the clinically most useful approach for the diagnosis and management of patients and families with heart muscle disease. In the ESC position statement published in 2008, cardiomyopathies were defined as myocardial disorders in which the heart muscle is structurally and functionally abnormal, and in which coronary artery disease, hypertension, valvular and congenital heart disease are absent or do not sufficiently explain the observed myocardial abnormality. The aim was to help clinicians look beyond generic diagnostic labels in order to reach more specific diagnoses. In parallel, a scientif...

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Section: Die Klassifikation Der Kardiomyopathien Der European Societyunclassified

Classification of Cardiomyopathies and Indication for Endomyocardial Biopsy Revisited

Pankuweit

Richter²,

Ruppert³

et al. 2009

Herz

View full text Add to dashboard Cite

show abstract

“…If, in a follow-up biopsy, these criteria persist, it is persistent myocarditis, if after positive initial biopsy it has disappeared, it is healed myocarditis, when infiltrating cells are missing from the beginning, it is no myocarditis. Giant cell myocarditis can be identified by histology only [8,38,52,53]. These criteria have been expanded to a quantification of the infiltrate best by immunohistochemistry using different monoclonal antibodies (mostly activated T-cells with CH45ro or T200) on cryostat sections with a background staining for vascular endothelium to avoid intravascular cells to be mistaken for an infiltrate.…”

Section: Suspected Fulminant Myocarditismentioning

confidence: 99%

“…However, the American Myocarditis Treatment Trial was underpowered, failed to distinguish between viral and autoreactive forms and did not use quantitative criteria for the assessment of inflammation. Since 2001 this restrictive attitude to biopsy in the USA has undergone gradual revision [52,53]. Hence further progress in the diagnosis and treatment of inflammatory cardiomyopathy was made in the European countries in the last 2 decades [14, 16-19, 21-30, 39-43, 47, 48, 50] or in Japan [46,49].…”

Section: Suspected Fulminant Myocarditismentioning

confidence: 99%

“…In Europe, however, endomyocardial biopsy was used more extensively in patients with suspected active or chronic myocarditis, particularly in symptomatic patients. Table 3 compares the current list of warranted indications for endomyocardial biopsy in the Mayo Clinic [52,53] and at the Marburg University Hospital. Since 2001 this restrictive attitude to biopsy in the USA has undergone gradual revision [52,53].…”

Section: Suspected Fulminant Myocarditismentioning

confidence: 99%

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Management of Patients with Suspected (Peri-)Myocarditis and Inflammatory Dilated Cardiomyopathy

Maisch

Richter²,

Koelsch³

et al. 2006

Herz

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Inflammatory cardiomyopathy and myocarditis are considered acquired forms of dilated cardiomyopathy. Whereas consensus documents on the diagnosis of myocarditis and perimyocarditis do exist, guidelines on the specific treatment have been established only for the management of pericardial diseases, which at least partly can be applied in analogy to myocarditis. Presently, feasible clinical pathways are available, which can lead to a correct diagnosis and specific treatment. This is illustrated with two cases of fulminant myocarditis, in one with successful diagnosis and treatment of a cardiac sarcoid and another one in which diagnostic nihilism led to a lethal outcome in giant cell myocarditis at necropsy. A case of active parvo B19-positive myocarditis demonstrates the role of immunoglobulin treatment under these conditions.

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“…1 More than 100 000 patients in the United States have a nonischemic dilated cardiomyopathy, and this disease accounts for 45% of all heart transplants. 2,3 More than 25% of the nonischemic dilated cardiomyopathy cases may be caused by viral infections. 4 The virus that most commonly infects the heart is Coxsackievirus, a small RNA virus (picornavirus) spread through the fecal-oral route.…”

mentioning

confidence: 99%

Integrin-Linked Kinase Plays a Key Role in Coxsackievirus Replication

Lowenstein

2006

Circulation Research

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Potential of the Right Ventricular Endomyocardial Biopsy to Diagnose and Assist in the Management of Congestive Heart Failure: Insights From Recent Clinical Trials

Cited by 8 publications

References 48 publications

Classification of Cardiomyopathies and Indication for Endomyocardial Biopsy Revisited

Classification of Cardiomyopathies and Indication for Endomyocardial Biopsy Revisited

Management of Patients with Suspected (Peri-)Myocarditis and Inflammatory Dilated Cardiomyopathy

Integrin-Linked Kinase Plays a Key Role in Coxsackievirus Replication

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