Echocardiogram Guided Endomyocardial Biopsy: An Analysis beyond Safety Outcomes

Abstract

Fluoroscopy-guided endomyocardial biopsy (FGEB) of the right ventricle is the common method for myocardial sampling for rejection among heart transplant patients. Echocardiographic-guided endomyocardial biopsy (EGEB) is safe, but few studies have compared the procedures outside of safety outcomes. Our hypothesis is that EGEB lowers radiation time without prolonging the total procedure. We retrospectively collected data from adult heart transplant endomyocardial biopsies via the right internal jugular access from 2/1/15-2/28/19. Differences of target variables between EGEB and FGEB groups were assessed by t test or Kruskal-Wallis test as appropriate. For binary target variables, chi-square-test was used; p < 0.05 was significant. There were 100 patients, 544 biopsies, 99 (18%) performed via EGEB by 2 of 5 transplant cardiologists. The mean biopsy time of the EGEB was 29.9 ± 10.3 min (95% CI: 27.9 - 32.0 min) compared to FGEB time of 29.7 ± 10.0 min (95% CI: 28.7 - 30.7 min), p = 0.75. Mean fluoroscopy time for EGEB was 1.83 ± 1.80 min (95% CI: 1.4-2.2 min) vs 5.58 ± 1.98 min (95% CI: 5.27-5.89 min) for FGEB, p < 0.0001. A measured mixed model analysis of mean fluoroscopy time accounting for patients receiving multiple endomyocardial biopsies showed a difference of 1.89 mins less with EGEB than FGEB (p < 0.0001). There were minimal adverse events with no statistical difference between groups: one pneumothorax and three new pericardial effusions in the FGEB group, with one new pericardial effusion in the EGEB group; none requiring intervention. EGEB is safe, decreases radiation exposure to patients and staff without extending procedural time. While the reduction in radiation time may be minimal, the cumulative dose can add up with a minimum of 11 biopsies performed 1 year after heart transplant alone.