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Left Ventricular Transradial Endomyocardial biopsy: a safe and effective approach
Session:
Sessão de Posters 01 - Intervenção não valvular
Speaker:
Ana Lobato de Faria Abrantes
Congress:
CPC 2024
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.3 Non-coronary Cardiac Intervention
Session Type:
Cartazes
FP Number:
---
Authors:
Ana Abrantes; Ana Beatriz Garcia; Ana Margarida Martins; Catarina Oliveira; Catarina Gregório; Miguel Raposo; Daniel Inácio Cazeiro; Tiago Rodrigues; João Agostinho; Dulce Brito; Miguel Nobre Menezes; Fausto J. Pinto
Abstract
<p style="margin-right:-3px; text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Introduction: </strong>Endomyocardial biopsy (EMB) outside the context of heart transplant is </span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">seldom performed due a perceived significant risk of complications. However, several </span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">studies have suggested that left ventricle EMB is safer and has a higher diagnostic yield that </span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">transvenous right ventricle biopsy, particularly if performed with a transradial approach.</span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Purpose:</strong> describe the safety and diagnostic yield of EMB performed under a structured </span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">program.</span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Methods:</strong> Single center observational prospective registry of consecutive non-heart </span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">transplant patients (pts) submitted to EMB from January 2017 to November 2023, after </span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">implementation of a structured program where left-sided and radial access were preferred </span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">unless unavailable/contraindicated. Success rate, complications and diagnostic yield were </span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">assessed. Student T test were used for comparison of continuous variables.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Results:</strong> We included 73 pts, 69% males, mean age 54 years. 64.4% of pts presented with </span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">congestive heart failure, 8.2% cardiogenic shock, 6.8% MINOCA, 6.8% complete </span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">atrioventricular block and 5 pts were asymptomatic (carriers of Val30Met mutation). The </span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">diagnostic suspicion was infiltrative cardiomyopathy in 62%, acute </span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">myocarditis in 22% (60% with cardiogenic shock and 40% chest pain with abnormal serum </span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">troponin) and chronic myocarditis in 16%. </span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">EMB was performed on average 42 days after clinical presentation and 7 days in pts with </span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">myocarditis/cardiogenic shock. </span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">Left-sided EMB was possible in 69 (95%) of pts and vascular access was radial in 95% of </span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">these. Only 4 right-sided EMB cases were undertaken with femoral (1) or jugular access (3). </span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">The success rate was 100%. On average 6.5 fragments were obtained, 86% from at least 3 </span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">locations, mainly antero-lateral, inferior and septal walls. Procedural related complications </span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">occurred only in 1 pt (ventricular fibrillation during the procedure, promptly cardioverted, with </span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">full recovery, no sequelae and successful procedural completion). All ambulatory pts (35) </span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">were discharged on the same-day. Anatomopathology identified cardiac amyloidosis in </span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">38% of pts, inflammatory infiltrate diagnostic of acute myocarditis in 21% and chronic </span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">myocarditis in 4%, and non-specific findings in 37% of pts. The overall diagnostic yield was </span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">63% and was highest for acute myocarditis (69%) and infiltrative cardiomyopathy (62%). </span></span></span></p> <p style="margin-right:-3px; text-align:justify"><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000"><strong>Conclusion:</strong> left-sided transradial EMB, in experienced hands, is highly successful and </span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">safe, with good diagnostic yield. These results data may allow clinicians to refer pts for EMB </span></span></span><span style="font-size:11pt"><span style="font-family:Arial,sans-serif"><span style="color:#000000">with higher confidence.</span></span></span></p> <p> </p>
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