Diagnostic yield, safety and therapeutic consequences of myocardial biopsy in clinically suspected fulminant myocarditis unweanable from mechanical circulatory support

Marquet, Yann; Hékimian, Guillaume; Lebreton, Guillaume; Kerneis, Mathieu; Rouvier, Philippe; Bay, Pierre; Mathian, Alexis; Bréchot, Nicolas; Chommeloux, Juliette; Petit, Matthieu; Gautier, Melchior; Lefevre, Lucie; Saura, Ouriel; Levy, David; Quentric, Paul; Moyon, Quentin; Ortuno, Sofia; Schmidt, Matthieu; Leprince, Pascal; Luyt, Charles-Edouard; Combes, Alain; Pineton de Chambrun, Marc

doi:10.1186/s13613-023-01169-y

Annals of Intensive Care

Table 4 Diagnosis and therapeutic consequences of noninvasive and biopsy-based diagnostic work-up

From: Diagnostic yield, safety and therapeutic consequences of myocardial biopsy in clinically suspected fulminant myocarditis unweanable from mechanical circulatory support

Variables	n = 47
Noninvasive diagnosis work-up
Diagnostic yield
Myocarditis	6 (13)
Alternate diagnosis	14 (30)
Decompensated dilated cardiomyopathy	11 (23)
MINOCA	2 (4)
Acute cardiomyopathy	1 (2)
Etiological diagnosis	22 (47)
Eosinophilic myocarditis	5 (11)
Connective tissue disease-related myocarditis^a	4 (8)
Chemotherapy-induced cardiomyopathy	3 (6)
Arrhythmic cardiomyopathy	2 (4)
Bacteria-induced cardiomyopathy^b	2 (4)
Post-partum cardiomyopathy	2 (4)
RNA polymerase III autoantibodies-associated myocarditis	1 (2)
Others^c	3 (6)
Therapeutic modifications	9 (19)
Immunosuppressant/immunomodulatory drugs^d	6 (13)
Antiviral therapy/antibiotics	2 (4)
Early cardiac transplantation	1 (2)
Biopsy-based diagnosis work-up
Diagnostic yield
Myocarditis	24 (51)
Lymphocytic myocarditis	13 (28)
Eosinophilic myocarditis	5 (11)
Giant-cell myocarditis	2 (4)
Borderline myocarditis	2 (4)
Alternate diagnosis	2 (4)
Myocardial infarction	1 (2)
Inherited cardiomyopathy	1 (2)
Absence of diagnosis	18 (38)
No myocardial sample	5 (11)
Virus-positive sample	7/39 (18)
Epstein-Barr Virus	4/39 (10)
Parvovirus B19	3/39 (8)
Etiological diagnosis	10 (21)
Eosinophilic myocarditis	5 (11)
Giant-cell myocarditis	2 (4)
Group B streptococcus myocarditis	1 (2)
Enterovirus-related myocarditis	1 (2)
EBV-related myocarditis	1 (2)
Therapeutic modifications	6 (13)
Immunosuppressant/immunomodulatory drugs^e	5 (11)
Antiviral therapy/antibiotics	1 (2)
Bonaca classification after biopsy results
Definite myocarditis	26 (55)
Probable myocarditis	21 (45)
Myocardial recovery under treatment	4 (8)
Noninvasive work-up driven treatment^f	2 (4)
Biopsy driven treatment^g	2 (4)

Continuous variables are expressed as median [interquartile range]; categorical variables are expressed as No. (%)
MINOCA myocardial infarction without obstructive coronary artery, RNA ribonucleic acid, EBV Epstein-Barr virus
^aSystemic sclerosis n = 1, idiopathic inflammatory myositis n = 1, catastrophic antiphospholipid syndrome n = 1, adult-onset Still’s disease n = 1
^bLyme’s disease n = 1, B group Streptococcus
^cAmniotic embolism n = 1, viral myocarditis n = 1, decompensated alcoholic cardiomyopathy n = 1
^dCorticosteroids alone n = 3, intravenous immunoglobulins alone n = 1, corticosteroids and intravenous immunoglobulins n = 1, anticoagulation, corticosteroids and plasma exchange/intravenous immunoglobulins (triple therapy) n = 1
^eAciclovir n = 1, corticosteroids n = 1, corticosteroids, thymoglobulins and mycophenolate mofetil n = 1
^fAntibiotics for Lyme’s disease n = 1, corticosteroids for eosinophilic myocarditis n = 1
^gCorticosteroids for eosinophilic myocarditis n = 2

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