Abstract
Endomyocardial biopsy (EMB) is the method of choice for diagnosing a wide range of myocardial diseases.Aim. To assess the rationale for diagnostic EMB in children and adults.Material and methods. Morphological and statistical analysis of 2803 diagnostic EMBs in adults (n=811) and children (n=83), including those in heart transplantation (n=1909), was carried out.Results. In 231 (28%) cases, adults were diagnosed with myocarditis, of which in 6 patients — granulomatous, in 5 — eosinophilic and in 6 — lymphocytic-macrophage myocarditis after coronavirus infection. In children, myocarditis was found in 22 cases (27%). Arrhythmogenic right ventricular dysplasia took the second place in detection rate in children and adults. Immunohistochemical study revealed viral envelope protein 1 (VP1) antigen of enteroviruses in one third of myocarditis cases, and in half — other cardiotropic viruses. Dotted dystrophin expression was observed in myocarditis. A correlation was established between the perforin expression and myocarditis presence (Pearson χ2=27,8; Fisher's exact test=27,3; p=0,01).Conclusion. Analysis of diagnostic EMB results confirmed its rationale in adults and children not only for heart transplantation, but also for identifying cardiac pathology, including for myocarditis diagnosis. It has been shown that immunohistochemical study with antiviral antibodies can be considered as an alternative method for detecting viral infection. An immunohistochemical analysis for perforin and dystrophin can be recommended as additional morphological markers of myocarditis.
Highlights
Эндомиокардиальная биопсия (ЭМБ) является методом выбора для диагностики широкого спектра заболеваний миокарда
In 231 (28%) cases, adults were diagnosed with myocarditis, of which in 6 patients — granulomatous, in 5 — eosinophilic and in 6 — lymphocyticmacrophage myocarditis after coronavirus infection
A correlation was established between the perforin expression and myocarditis presence (Pearson χ2=27,8; Fisher’s exact test=27,3; p=0,01)
Summary
ЭМБ играет важную роль в описании патофизиологии кардиотоксичности на фоне терапии ингибиторами иммунных контрольных точек и при поражении миокарда у больных с тяжелой коронавирусной инфекцией [1]. В 2021г Ассоциация сердечной недостаточности Европейского общества кардиологов, Американское общество сердечной недостаточности и Японское общество сердечной недостаточности обновили позиции по показаниям к ЭМБ, следуя которым эта манипуляция показана при следующих ситуациях [2]: Подозрение на фульминантный/острый миокардит, протекающий с ОСН, дисфункцией ЛЖ и/или нарушениями ритма. ДКМП с недавним началом СН, дисфункцией ЛЖ средней и тяжелой степени, резистентная к стандартному лечению. Существующие рекомендации относительно ЭМБ имеют ограничения, поскольку они не основываются на контролируемых и рандомизированных клинических исследованиях, поэтому Ассоциация европейских сердечно-сосудистых патологов (AECVP) и Общество сердечно-сосудистой патологии (SCP) разработали и рекомендуют использовать следующие уровни рекомендаций [3]:. Таблица 1 Диагностический потенциал ЭМБ при сердечных заболеваниях с классификацией рекомендаций
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