Endomyocardial biopsy safety and clinical yield in pediatric myocarditis: An Italian perspective.
OBJECTIVE
The objective of this investigation is to evaluate the safety, the impact of endomyocardial biopsy (EMB) results in myocarditis management and the incidence of different etiologies of myocarditis in a pediatric population.


BACKGROUND
Although EMB is an established diagnostic tool to evaluate suspected myocarditis, there is lack of clear diagnostic and management guidelines for myocarditis in pediatric patients, particularly in infants.


METHODS
We performed a retrospective database review and subsequent outcomes analysis from five Italian pediatric cardiology centers to identify patients aged 0-18 years who underwent EMB for suspected myocarditis or inflammatory cardiomyopathy (ICMP) between 2009 and 2011.


RESULTS
EMB was performed in 41 children, of which 16 were male. The population ranged between 16 days of age to 17 years (mean age at EMB = 5.2 ± 4.9 years). The overall incidence of EMB-related complications was 15.5% (31.2% in infants, and 6.8% in children > 1 year of age; P = 0.079) while the incidence of EMB-driven treatment changes was 29.2%. Histological examination together with PCR on heart biopsy specimens allowed an etiological diagnosis in 26/41 patients (63%). Among the 15 patients (36.5%) with diagnosis of dilated cardiomyopathy (DCM) 11 had idiopathic DCM. Finally, we found an overall incidence of death/cardiac transplantation of 24%.


CONCLUSIONS
In a pediatric population with suspected myocarditis/ICMP, EMB was useful in confirming the diagnosis only in 41% of cases but showed an overall diagnostic power of 63%. As complications of EBM are not negligible, particularly in infants, the risk/benefit ratio should be taken into account in each patient.
Department of Experimental, Diagnostic and Specialty Medicine, Pediatric Cardiology and Adult Congenital Unit, University of Bologna, S.Orsola-Malpighi University Hospital, Bologna, Italy.
Maurizio
http://orcid.org/0000-0001-7322-2112
M
Brighenti
Department of Experimental, Diagnostic and Specialty Medicine, Pediatric Cardiology and Adult Congenital Unit, University of Bologna, S.Orsola-Malpighi University Hospital, Bologna, Italy.
Andrea
A
Donti
Department of Cardiology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy.
Maria
M
Giulia Gagliardi
Pediatric Cardiology Unit, Department of Pediatrics, University of Padua, Italy.
Nicola
N
Maschietto
Pediatric Cardiology Division, Città Della Salute E Della Scienza - Children's Hospital Regina Margherita, Turin, Italy.|Cardio-Thoracic Department, Città Della Salute E Della Scienza - Children's Hospital Regina Margherita, Turin, Italy.
Davide
D
Marini
Pediatric Cardiology, Azienda-Policlinico, Giovanni XXIII Pediatric Hospital, Bari, Italy.
Maristella
M
Lombardi
Pediatric Cardiology, Azienda-Policlinico, Giovanni XXIII Pediatric Hospital, Bari, Italy.
Ugo
U
Vairo
Pediatric Cardiology Division, Città Della Salute E Della Scienza - Children's Hospital Regina Margherita, Turin, Italy.|Cardio-Thoracic Department, Città Della Salute E Della Scienza - Children's Hospital Regina Margherita, Turin, Italy.
Gabriella
G
Agnoletti
Pediatric Cardiology Unit, Department of Pediatrics, University of Padua, Italy.
Ornella
O
Milanesi
Department of Cardiology, IRCCS Bambino Gesù Children's Hospital, Rome, Italy.
Giacomo
G
Pongiglione
Department of Experimental, Diagnostic and Specialty Medicine, Pediatric Cardiology and Adult Congenital Unit, University of Bologna, S.Orsola-Malpighi University Hospital, Bologna, Italy.
Marco
M
Bonvicini
D000293:Adolescent; D000367:Age Factors; D001706:Biopsy / Q000009:adverse effects; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007558:Italy / Q000453:epidemiology; D008297:Male; D009205:Myocarditis / Q000453:epidemiology / Q000473:pathology* / Q000628:therapy; D009206:Myocardium / Q000473:pathology*; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
dilated cardiomyopathy; endomyocardial biopsy; myocarditis; pediatric