Podsumowanie

Biopsja endomiokardialna pozostaje ważnym, niekiedy rozstrzygającym narzędziem diagnostycznym w chorobach mięśnia sercowego. W ostatnich kilku latach daje się zauważać ponowny wzrost znaczenia tego narzędzia diagnostycznego, szczególnie w aspekcie poszukiwania nowych wskaźników patologii mięśniowej, a także nowych sposobów postępowania leczniczego. W ten nurt wpisują się też badania autorów32, ukierunkowane na poszerzenie panelu diagnostyczno-badawczego o nowe markery schorzeń mięśnia sercowego. Celowi temu będzie także służyło budowane właśnie w Zabrzu Śląskie Laboratorium Nanomikroskopii Śląskiego Uniwersytetu Medycznego. Nowoczesne techniki badawcze (mikroskopia elektronowa, w tym reżimu kriogenicznego, mikroskopia sił atomowych, mikroskopia holograficzna czy mikroskopia konfokalna wysokiej rozdzielczości) umożliwią, w opinii autorów, osiągnięcie innego poziomu oceny histologicznej zmierzającej do personalizacji diagnostyki i leczenia schorzeń mięśnia sercowego.


Na potrzeby niniejszego artykułu przyjęto podział kardiomiopatii wg American Heart Association z 2006 roku

ABSTRACT

Myocardial biopsy in the diagnosis of cardiomyopathy

Since introduced in 1962, myocardial biopsy has been an essential component of intravital diagnosis of myocardial conditions. However, given that this procedure is invasive and produces a number of complications, and taking into account the limited range of bioptomes, which covers only the subendocardial layer, and the dynamic development of non-invasive heart examination methods, the list of indications for endomyocardial biopsy has been significantly reduced. Currently, this type of cardiac diagnosis is mostly used for diagnosing and guiding therapeutic management of inflammatory processes as well as for monitoring patients after heart transplant surgery. The development of nanomedicine, and thus personalized medicine, opens a new chapter in biopsy-based diagnosis of the myocardium. Of key importance here is the use of new examination methods, e.g. cryogenic electron microscopy, for examination of endomyocardial segments and for subsequent personalized diagnosis and treatment.

Piśmiennictwo

1. Sakakibara S., Konno S. Endomyocardial biopsy. Jpn Heart J 1962;3:537-43

2. Costanzo MR, Dipchand A, Starling R, et al. The International Society of Heart and Lung Transplantation Guidelines for the care of heart transplant recipients. J Heart Lung Transplant 2010;29:914-56

3. From AM, Maleszewski JJ, Rihal CS. Current status of endomyocardial biopsy. Mayo Clin Proc 2011;86:1095-102

4. Cooper LT. The role of left ventricular biopsy in the management of heart disease. Circulation 2013;128:1492-4

5. Yilmaz A, Kindermann I, Kinderman M, et al. Comparative evaluation of left and right ventricular endomyocardial biopsy: differences in complication rate and diagnostic performance. Circulation 2010;122:900-9

6. Stiermaier T, Föhrenbach F, Klingel K, et al. Biventricular endomyocardial biopsy in patients with suspected myocarditis: feasibility, complication rate and additional diagnostic value. Int J Cardiol 2017;230:364-70

7. Mahrholdt H, Goedecke C, Wagner A, et al. Cardiovascular magnetic resonance assessment of human myocarditis. Circulation 2004;109:1250-8

8. Aretz HT. Myocarditis: The Dallas criteria. Hum Pathol 1987;18:619-24

9. O’Connell JB. The role of myocarditis in end-stage dilated cardiomyopathy. Tex Heart Inst J 1987;14:268-75

10. Kuhl U, Noutsias M, Seeberg B, et al. Immunohistological evidence for a chronic intramyocardial inflammatory process in dilated cardiomyopathy. Heart 1996;75:295-300

11. Wojnicz R, Nowalany-Kozielska E, Wodniecki J, et al. Immunohistological diagnosis of myocarditis. Potential role of sarcolemmal induction of the MHC and ICAM-1 in the detection of autoimmune mediated myocyte injury. Eur Heart J 1998;19:1564-72

12. Noutsias M, Seeberg B, Schultheiss HP, et al. Expression of cell adhesion molecules in dilated cardiomyopathy. Evidence for endothelial activation in inflammatory cardiomyopathy. Circulation 1999;99:2124-31

13. Maron BJ, Towbin JA, Thiene G, et al. Contemporary Definitions and Classification of the Cardiomyopathies. Circulation 2006;113:1807-16

14. van den Heuvel AFM, van Veldhuisen DJ, van der Wall EE, et al. Regional myocardial blood flow reserve impairment and metabolic changes suggesting myocardial ischemia in patients with idiopathic dilated cardiomyopathy. J Am Coll Cardiol 2000;35:19-28

15. Cooper LT, Baughman KL, Feldman Am, et al. The role of endomyocardial biopsy in the management of cardiovascular disease: a scientific statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology. Circulation 2007;116:2216-33

16. Wojnicz R. Immunosuppressive therapy for heart failure. In: Dec GW (ed.). Heart Failure Clinics: Myocarditis. WB Saunders 2005:449-56

17. Wojnicz R. Biopsja mięśnia sercowego i osierdzia. W: Podolec P, Jankowska EA, Ponikowski P, Banasiak W (red.). Przewlekła niewydolność serca. Tom II. Medycyna Praktyczna 2009:321-9

18. Wojnicz R, Nowalany-Kozielska E, Wojciechowska C, et al. Randomized, placebo-controlled study for immunosuppressive treatment of inflammatory dilated cardiomyopathy. Two-years follow-up results. Circulation 2001;104:39-45

19. Trachtenberg BH, Hare JM. Inflammatory cardiomyopathic syndromes. Circ Res 2017;121:803-18

20. Cooper LT, Hare JM, Tazelaar HD, et al. Usefulness of immunosuppression for giant cell myocarditis. Am J Cardiol 2008;102:1535-9

21. Kandolin R, Lehtonen J, Salmenkivi K, et al. Diagnosis, treatment, and outcome of giant-cell myocarditis in the era of combined immunosuppression. Circ Heart Fail 2013;6:15-22

22. Muchtar E, Blauwet LA, Gertz MA. Restrictive cardiomyopathy. Genetics, pathogenesis, clinical manifestations, diagnosis and therapy. Circ Res 2017;121:819-837

23. Collins AB, Smith RN, Stone JR. Classification of amyloid deposits in diagnostic cardiac specimens by immunofluorescence. Cardiovasc Pathol 2009;18:205-216

24. Maleszewski JJ. Cardiac amyloidosis: pathology, nomenclature, and typing. Cardiovasc Pathol 2015;24:343-50

25. Ardehali H, Howard DL, Hariri A, et al. A positive endomyocardial biopsy result for sarcoid is associated with poor prognosis in patients with initially unexplained cardiomyopathy. Am Heart J 2005;150:459-63

26. Yazaki Y, Isobe M, Hiramitsu S, et al. Comparison of clinical features and prognosis of cardiac sarcoidosis and idiopathic dilated cardiomyopathy. Am J Cardiol 1998;82:537-540

27. Perrot A, Osterziel KJ, Beck M, et al. Fabry disease: focus on cardiac manifestations and molecular mechanisms. Herz 2002;27:699-702

28. Nakao S, Takenaka T, Maeda M, et al. An atypical variant of Fabry’s disease in men with left ventricular hypertrophy. N Engl J Med 1995;333:288-93

29. Thurberg BL, Fallon JT, Mitchell R, et al. Cardiac microvascular pathology in Fabry disease: evaluation of endomyocardial biopsies before and after enzyme replacement therapy. Circulation 2009;119:2561-7

30. Billingham ME, Mason JW, Bristow MR, et al. Anthracycline cardiomyopathy monitored by morphologic changes. Cancer Treat Rep 1978;62:865-72

31. Witte DL, Crosby WH, Edwards CQ, et al. Practice guideline development task force of the College of American Pathologist. Hereditary hemochromatosis. Clin Chim Acta 1996;245:139-200

32. Reichman-Warmusz E, Domal-Kwiatkowska D, Matysiak N, et al. Tissue Factor is unregulated in microvascular endothelial cells of patients with heart failure. J Clin Pathol 2016;69:221-5

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