Endomyocardial biopsy practice in non-transplant patients: a nationwide descriptive study

Abstract

Abstract Background Endomyocardial biopsy (EMB) is an invasive diagnostic tool, mainly used during the follow-up of heart transplant patients (HTx). Its others indications have been established and discussed in position statement paper from international cardiac societies. However the use of EMB in real life remains controversial and differs widely from a center to another. Purpose We carried out a nationwide survey to describe the current use of EMB in non-heart transplant patients. Methods We used the National Hospital Discharge Database (PMSI) that contains diagnostic codes of all hospitalizations. Medical data is coded from different sources (e.g. laboratory reports, discharge reports) according defined terminologies and coding rules. We included all hospitalizations during which EMB (code CCAM DAHF001 – Endocardium or Myocardium Biopsy, transcutaneous vascular access) was performed from January 1st 2019 to December 31th 2020. We excluded all patients with a main or secondary or associated diagnosis of heart transplant. Main diagnosis as well as secondary and associated diagnoses were collected in order to define the medical indication of EMB. We aggregated EMB indications into 8 groups. Results Among 9735 EMB, 914 (9%) were carried out for non-transplant patients during the 2 years of analysis. Among the 212 hospitals with interventional cardiology units, only 53 (25%) carried out EMB in non-transplant patients and 86% of these procedures were carried out in transplant centers. Three hospitals carried out 37% of all non-transplant EMB while 23 centers carried out no more than 5 EMB over the 2-year survey. The figure displays main indications of EMB in non-transplant patients. According to the PMSI database, the 3 main indications of EMB were amyloïdosis (29%), non-ischemic Dilated Cardiomyopathy (28%) and myocarditis (22%). The medical indication could not be specified in 155 (16%) patients. Conclusion In non-transplant patients, EMB is rarely performed in France, only in a few hospitals and with significant disparity in the annual rate of procedures carried out by each. Most EMB were performed because of amyloidosis or dilated cardiomyopathy and myocarditis. Further data about local constraints as well as clinical impact of EMB for each patient would be useful to understand further the role of EMB in real life.EMB indications in non HTx patients