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Safety and prognostic value of left ventricular endomyocardial biopsy in dilated cardiomyopathy

Aims The need to perform endomyocardial biopsy (EMB) in patients with non-ischaemic dilated cardiomyopathies (DCM) is debated. Here we sought to determine the extent of left ventricular collagen volume fraction (LV-CVF) in DCM patients and to evaluate it as a prognostic marker. Methods and results I...

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Main Authors: Kayvanpour, Elham (Author) , Sedaghat-Hamedani, Farbod (Author) , Li, Daniel Tian (Author) , Amr, Ebe (Author) , Amr, Ali (Author) , Lahrmann, Bernd (Author) , Lai, Chung Lun Alan (Author) , Reich, Christoph (Author) , Wang, Chenyang (Author) , Herpel, Esther (Author) , Mereles, Derliz (Author) , Frankenstein, Lutz (Author) , Grabe, Niels (Author) , Katus, Hugo (Author) , Frey, Norbert (Author) , Meder, Benjamin (Author)
Format: Article (Journal)
Language:English
Published: 19 September 2025
In: European journal of heart failure
Year: 2025, Volume: 27, Issue: 12, Pages: 3029-3039
ISSN:1879-0844
DOI:10.1002/ejhf.70019
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1002/ejhf.70019
Verlag, kostenfrei, Volltext: https://onlinelibrary.wiley.com/doi/abs/10.1002/ejhf.70019
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Author Notes:Elham Kayvanpour, Farbod Sedaghat-Hamedani, Daniel Tian Li, Ebe Amr, Ali Amr, Bernd Lahrmann, Alan Lai, Christoph Reich, Chenyang Wang, Esther Herpel, Derliz Mereles, Lutz Frankenstein, Niels Grabe, Hugo A. Katus, Norbert Frey, and Benjamin Meder
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Summary:Aims The need to perform endomyocardial biopsy (EMB) in patients with non-ischaemic dilated cardiomyopathies (DCM) is debated. Here we sought to determine the extent of left ventricular collagen volume fraction (LV-CVF) in DCM patients and to evaluate it as a prognostic marker. Methods and results In this retrospective longitudinal study, we included 524 patients with suspected DCM who underwent left ventricular EMB (LV-EMB) as a part of their clinical work-up. LV-CVF was quantified using automated image processing of high-resolution scans of LV-EMB. Deep phenotyping was performed including assessment of late gadolinium enhancement on cardiac magnetic resonance imaging. Endpoints were (i) composite endpoint of heart failure-related death, sudden cardiac death, aborted sudden cardiac death (appropriate implantable cardioverter-defibrillator shock, reported sustained ventricular tachycardia, or cardiopulmonary resuscitation), or cardiac transplantation, and (ii) all-cause mortality. LV-EMB was associated with 0.76% major and 2.1% minor complications. No death occurred due to EMB. LV-CVF could be reliably quantified using Bayesian classification. During a median follow-up of 43.2 months (2084 patient-years), 48 patients with LV-CVF >32% and 14 patients with LV-CVF ≤32% reached the composite endpoint (log-rank p < 0.0001). A total of 62 patients reached the endpoint all-cause mortality, from which 38 presented with LV-CVF >32% and 17 with LV-CVF ≤32% (log-rank p = 0.009). In multivariable analyses, LV-CVF and N-terminal pro-B-type natriuretic peptide (NT-proBNP) (hazard ratio 2.03, 95% confidence interval 1.32-3.11) were independent predictors of unfavourable outcome. Conclusions Left ventricular EMB is a safe diagnostic procedure. The extent of CVF in LV-EMB provides prognostic information in patients with DCM in addition to existing measures of left ventricular ejection fraction or NT-proBNP.
Item Description:Gesehen am 03.02.2026
Physical Description:Online Resource
ISSN:1879-0844
DOI:10.1002/ejhf.70019

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