ROLE OF ENDOMYOCARDIAL BIOPSY IN DIFFERENTIAL DIAGNOSIS OF NON-ISCHEMIC CARDIOMYOPATHY

Introduction: Non-ischemic cardiomyopathies are a common cause of heart failure. This is a heterogeneous group that requires very detailed differential diagnosis, which results in targeted therapy of the underlying disease and an effort to improve the prognosis of these patients.

Aim: Assessment of the role of endomyocardial biopsy in the management of patients with non-ischemic cardiomyopathy.

File and methodology: Prospective evaluation of 151 patients who underwent endomyocardial biopsy (EMB), echocardiography, magnetic resonance imaging and basic laboratory tests. In our group of patients, the final diagnosis was determined on the basis of the overall clinical picture in 53% of patients, in 36.4% of patients it was confirmed histologically (predominantly myocarditis, TTR and AL amyloidosis). The diagnosis of myocarditis was confirmed in 42 cases. The sensitivity and specificity of the EMB in myocarditis were 93.3% and 93.3%, respectively.100%. Amyloidosis was biopsied in 10 cases. In the case of amyloidosis, the sensitivity and specificity of the EMB were 100%. In the group of our patients, we compared the result of magnetic resonance imaging of the heart with a histological finding - a discrepancy was found in 45 cases (32.8%). In 25 cases, specific myocardial involvement was histologically demonstrated and the conclusion of magnetic resonance imaging was negative, on the contrary, in 20 cases without proven specific myocardial involvement, the result of magnetic resonance imaging was positive.

Conclusion: Non-ischemic cardiomyopathies are a very heterogeneous group. Due to this fact, a comprehensive approach to diagnosis is necessary, which combines both imaging and laboratory methods and in indicated cases endomyocardial biopsy. Early diagnosis is necessary to initiate specific therapy and thus influence the prognosis of patients.