“…Advanced systemic diseases affecting short‐term prognosis, pericardial diseases, congenital heart diseases, cor pulmonale, persistent supraventricular tachyarrhythmias, severe organic valve diseases and a clinical presentation concordant with acute coronary syndrome, including stress cardiomyopathy, 13 were considered as exclusion criteria. Active myocarditis was excluded based on clinical criteria, and, when suspected, by cardiac magnetic resonance and/or endomyocardial biopsy according to our internal protocol and current international recommendations 14 …”
The recent definition of heart failure with improved ejection fraction outlined the importance of the longitudinal assessment of left ventricular ejection fraction (LVEF). However, long-term progression and outcomes of this subgroup are poorly explored. We sought to assess the LVEF trajectories and their correlations with outcome in non-ischaemic dilated cardiomyopathy (NICM) with improved ejection fraction (impEF).
“…Advanced systemic diseases affecting short‐term prognosis, pericardial diseases, congenital heart diseases, cor pulmonale, persistent supraventricular tachyarrhythmias, severe organic valve diseases and a clinical presentation concordant with acute coronary syndrome, including stress cardiomyopathy, 13 were considered as exclusion criteria. Active myocarditis was excluded based on clinical criteria, and, when suspected, by cardiac magnetic resonance and/or endomyocardial biopsy according to our internal protocol and current international recommendations 14 …”
The recent definition of heart failure with improved ejection fraction outlined the importance of the longitudinal assessment of left ventricular ejection fraction (LVEF). However, long-term progression and outcomes of this subgroup are poorly explored. We sought to assess the LVEF trajectories and their correlations with outcome in non-ischaemic dilated cardiomyopathy (NICM) with improved ejection fraction (impEF).
“…Of note, LV EMB is associated with a higher risk of stroke or systemic embolism. Therefore, when posing indications to EMB, the risk/benefit balance should be accurately evaluated and the procedure should be performed in high-volume centres with specific expertise to minimize the risk of such complications [ 2 ]. Fig.…”
Section: Emb: the Procedural Steps In The Lab And Potential Issuesmentioning
confidence: 99%
“…It should be always considered that EMB is an invasive procedure to be used after careful consideration of risks and benefits [ 24 ]. EMB has some limitations [ 2 ] : (a) its accuracy is not 100% and inconclusive results are possible in clinical practice, (b) it is associated with a modest, but still relevant, risk of potential major procedural complications, (c) the presence of mild myocardial histological changes is not always clinically relevant and does not address a specific therapeutic approach, and (d) it requires cardiac pathologists with experience in the interpretation of histological findings. Finally, some absolute contraindications to EMB should be considered such as the presence of intracardiac thrombus, ventricular aneurysm, severe tricuspid, pulmonary or aortic stenosis and tricuspid or aortic prosthesis [ 9 ].…”
Section: Emb Use In Selected Controversial Scenariosmentioning
confidence: 99%
“…EMB incremental diagnostic, prognostic and therapeutic value has led to a wide diffusion of this technique over the years in different settings. Nevertheless, a significant heterogeneity exists in EMB use in clinical practice, probably due to its low sensitivity in specific scenarios, the development of non-invasive diagnostic techniques, the non-negligible risk of major complications especially in non-experienced centres and the limited availability of skilled cardio-pathologists for the interpretation of histological findings, outside referral centres [ 2 ].…”
Endomyocardial biopsy (EMB) is an invasive procedure originally developed for the monitoring of heart transplant rejection. Over the year, this procedure has gained a fundamental complementary role in the diagnostic work-up of several cardiac disorders, including cardiomyopathies, myocarditis, drug-related cardiotoxicity, amyloidosis, other infiltrative and storage disorders, and cardiac tumours. Major advances in EMB equipment and techniques for histological analysis have significantly improved diagnostic accuracy of EMB. In recent years, advanced imaging modalities such as echocardiography with three-dimensional and myocardial strain analysis, cardiac magnetic resonance and bone scintigraphy have transformed the non-invasive approach to diagnosis and prognostic stratification of several cardiac diseases. Therefore, it emerges the need to re-define the current role of EMB for diagnostic work-up and management of cardiovascular diseases. The aim of this review is to summarize current knowledge on EMB in light of the most recent evidences and to discuss current indications, including challenging scenarios encountered in clinical practice.
“…Endomyocardial biopsy (EMB) has been progressively limited as a diagnostic tool, but it still represents an important technique to reach a definite as well as an etiological diagnosis in controversial cases [ 72 ]. The analysis of the data from the ‘Cardiac Amyloidosis Registry’ of Trieste from January 1990 to December 2020 clearly shows that patients in the contemporary cohort (67% ATTR-CA) are diagnosed more frequently using the non-invasive approach compared to those in the historical cohort [ 73 ].…”
Section: Challenges In Diagnosis and Treatment In Camentioning
The epidemiology of cardiac amyloidosis (CA), traditionally considered a rare and incurable disease, has changed drastically over the last ten years, particularly due to the advances in diagnostic methods and therapeutic options in the field of transthyretin CA (ATTR-CA). On the one hand, the possibility of employing cardiac scintigraphy with bone tracers to diagnose ATTR-CA without a biopsy has unveiled the real prevalence of the disease; on the other, the emergence of effective treatments, such as tafamidis, has rendered an early and accurate diagnosis critical. Interestingly, the following subgroups of patients have been found to have a higher prevalence of CA: elderly subjects > 75 years, patients with cardiac hypertrophy hospitalized for heart failure with preserved ejection fraction, subjects operated on for bilateral carpal tunnel syndrome, patients with cardiac hypertrophy not explained by concomitant factors and individuals with aortic valve stenosis. Many studies investigating the prevalence of CA in these particular populations have contributed to rewriting the epidemiology of the disease, increasing the awareness of the medical community for a previously underappreciated condition. In this review, we summarized the latest evidence on the epidemiology of CA according to the different clinical settings typically associated with the disease.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
