ENDOMYOCARDIAL BIOPSY-BASED DIAGNOSTICS OF INFLAMMATORY CARDIOMYOPATHY - BASELINE ANALYSES OF THE PILOT STUDY

Background: the diagnostics of inflammatory cardiomyopathy (ICM) is nowadays based mainly on the results of endomyocardial biopsy (EMB). Classical histological assessment is insufficient; there is an absolute necessity of imunohistological and genetical evaluation focused on the detection of nucleic acids of potential patogens in endomyocardial biopsy (EMB) specimens.

Patients group: there were 30 patients with the symptoms of heart failure lasting less than 12 months and no alternative etiology of heart failure evaluated since December 2009 till Decembre 2010. The mean age was 43 ±13 years, 7 of the patients were women, time since the first symptoms was 2.4 ± 2.1 months. Left ventricle ejection fraction was 23 ± 8 %, NYHA class 2.8 ± 0.5.
Methods: ICM was defined as the presence of ›14 leucocytes (LCA+) and/or ›7 T-lymphocytes (CD3+)/ mm2 in EMB samples. Polymerase chain reaction (PCR) assays for detection of viral genome were focused on parvovirus B19, human herpes virus-6, enterovirus, adenovirus, cytomegalovirus, Ebstein-Baar virus, and on borrelia burgdoferi genome.
Results: immunohistological evidence of ICM was found in 20 cases (67%). In 9 of these 20 cases, the results were positive for both CD3+ and LCA+ cells (that is in 45% of all ICM patiens and 30% of the whole patients group); remaining 11 cases were only LCA+ positive. The presence of viral genome in the myocardium was detected in 15 cases (i.e. 50%). In the group of proven ICM, the PCR was positive in 11 of 20 cases (53%).

Conclusion: the role of EMB in the diagnostics of ICM is unsubstitutable. Recent DCM has in 2/3 of our patients group an inflammatory basis. Immunosupresive therapy was limited to 1/3 of the group because of the presence of viral nucleic acid in the myocardium.