03 Sep 2006

Cardiomyopathy, Diagnostic & therapeutic intervention

Dr. Sabine Pankuweit

Topics: Myocardial Disease
Session number: 928000
Session title: Cardiomyopathies: diagnostic and therapeutic interventions Symposium
Authors: Pankuweit, S. Marburg, Germany

The session started with an excellent report on the recently published guidelines regarding the diagnostic procedures in patients with acute and chronic pericarditis given by Prof. Seferovic from Belgrade.

Prof. Seferovic pointed out that pericardioscopy using a flexible pericardioscope is a very safe intervention. Puncture of the fluid - and in addition the careful examination of pericardial fluid and the epicardial and pericardial biopsies using molecular and immunohistochemical methods - as well as the detection of tumor cells or bacteria, is extremely helpful in establishing a specific diagnosis in a given patient.

It was discussed after the talk that these tools should be used in patients with acute and chronic pericarditis as well, having in mind that this specific diagnostic procedure has an therapeutic impact. For patients with malignancies and patients with chronic autoreactive pericarditis an intrapericardial treatment has been reported, which show that the risk of recurrency of pericardial effusion is reduced. In patients with autoreactive pericarditis, which were treated intrapericardialy with triamcinolone, a viral pericarditis has to be excluded by molecular methods before starting therapy.

Dr. Pauschinger from Berlin gave an excellent talk on the diagnostic and therapeutic impact of the endomycardial biopsy. He started with the feasibility of the procedure and reported a very low complication rate in the hands of an experienced investigator. He pointed out that the indication for endomycardial biopsy is given in all patients with new onset of heart failure, suspected acute myocardial disease and patients with chronic non-ischemic heart failure.

Sensitivity and specificity with regard to the diagnosis of an inflammatory, viral, bacterial or storage disease including Fabry disease, amyloidosis etc. depend on sample number (8-10 in minimum) and usage of all important methods (molecular biology and immunohistochemistry). Treatment trial in several patients subgroups have shown, that there is a benefit from a specific therapy on top of the heart failure therapy, if a specific diagnosis is established.

Dr. Pellerin from London gave an excellent and well balanced talk on the hot discussed topic of echo guided septal branch occlusion in patients with hypertrophic cardiomyopathies. Indication for septal ablation is given in patients with severe left ventricular outflow obstruction and unresponsivness to medical therapy. Within the catheter laboratory he recommended the usage of multiple views in parallel to an contrast echocardiography to get the right position and to see the septal brunch to be occluded. He treated more than 330 patients using this procedure leading to only 11% of patients with persisting symptoms, a very low mortality and a low number of after procedure pacemaker implantations.

Dr. Friedrich from Calgary summarized the diagnostic targets of cardiac MRI in patients with cardiomypathies, which focus on the volume, function, morphology and mass of the myocardium. A special impact of MRI is the possibility of investigating tissue pathology, where it is possible, to distinguish different disease entities, for example ARVC, Fabry disease or amyloidosis.

Regarding the diagnosis of mycarditis, he reported on a consensus meeting for the definition of diagnostic criteria using MRI. Criteria for the diagnosis using MRI are the detection of hyperemia (capillary leakage), oedema and scar imaging as an equivalent for myocyte injury and the extend of necrosis. Conclusion It was an excellent meeting giving an overview with respect to different procedures, which all have an impact in establishing a specific diagnosis. The discussions where fruitful with a high resonance of the auditorium. Unfortunately, the time was too short to discuss all questions, indicating the pericardioscopy, endomyocardial biopsy, echo guided septal brunch occlusion and cardiac MRI are procedures with high clinical impact.

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.