Z Kardiol 94: Suppl 2 (2005)

Endomyocardial catheter biopsy (EMCB) in sarcoid heart disease : investigations in the additional guiding of biopsy by non-invasive image modalities to minimize sampling error   
G. Beer1, T. Lawrenz2, J. Reinhardt2, H. Kuhn2, Ch. Stellbrink2
1, Bielefeld, BusinessLogic.Land; 2Klinik f. Kardiologie und intern. Intensivmedizin, Städt. Kliniken Bielefeld, Klinikum Mitte, Bielefeld;
An early diagnosis of sarcoid heart disease (SHD) is clinically important for therapeutic and prognostic reasons. Only few and conflicting reports about the value of EMCB are at issue. Methods : EMCB was performed in 12 pts for the detection of SHD. We performed right ventricular EMCB in 11 consecutive pts  with established clinical and bioptic (extracardiac tissue) diagnosis of sarcoidosis. In these pts there was strong clinical suspicion of cardiac involvement. In these 11 pts conventional echocardiography (TTE) and left / right ventricular angiogram (A) were performed for the guiding of EMCB. Additional we performed repeat EMCB in a 34 year old female pt with clinical features of hypertrophic cardiomyopathy first guided by conventional imaging techniques (TTE, A) and afterwards guided by additional cardiac magnetic resonance imaging (MRI) and tissue Doppler echocardiography (TDI). Results : Only in 1 pt (1 / 11 pts; 9 %) EMCB ,guided by TTE and A, revealed noncaseating granulomas being diagnostic for cardiac sarcoidosis in 1 out of 4 obtained tissue samples. In the single pt without prior diagnosis of extracardiac sarcoidosis multiple EMCB were negative. Because of clinical suspicion of infiltrating heart disease, we performed in this pt again repeat biventricular septal EMCB which were now guided by prior MRI and TDI investigations both suggesting localized infiltrative heart disease in the septal region. Now EMCB in this pt revealed pronounced findings of sarcoid heart disease. Conclusion : The diagnostic value of EMCB in the diagnosis of cardiac sarcoidosis even in pts with established extracardiac sarcoidosis and strong clinical suspicion of cardiac involvement is low due to the influence of sampling error. EMCB guided by conventional imaging techniques (TTE, A) does not solve this problem. However, when the localization of EMCB was guided by MRI and TDI, biopsy revealed unequivocal sarcoid heart disease in the same pt.