The determination of the histopathological differences in endomyocardial biopsy (EMB) findings between men and women with new onset heart failure in a tertiary referral hospital.

Dieudonné, C.L. (2016) The determination of the histopathological differences in endomyocardial biopsy (EMB) findings between men and women with new onset heart failure in a tertiary referral hospital. thesis, Medicine.

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Abstract

In the present study we focussed on determining the histopathological differences in endomyocardial biopsy (EMB) findings between men and women with new onset heart failure in a tertiary referral hospital. Moreover, we analysed the association of the histopathological variables with the diagnosis of myocarditis and assessed the rate of change of the therapeutic regimen after EMB. EMB is an invasive procedure to establish a pathological diagnosis of various heart diseases, which are etiologic factors in (new onset) heart failure, including myocarditis. Previous studies have challenged its diagnostic potential, by relating the clinical gain against procedural risks in specific clinical scenarios. Patients with new onset heart failure exhibited the best risk-benefit-ratio. Sex differences with regard of the EMB procedure have not been studied so far. Previous experimental studies showed, that females have an overall stronger immune response then men, explaining the higher frequencies of (viral) myocarditis in males. However, studies on human biopsy tissue are limited. Our study showed that women had significantly higher levels of immunehistochemical (IHC) markers in EMB findings then men. In particular, ICAM-1 exhibited a different association with myocarditis between men and women depending on the height of the ICAM-1 level. This should be prospectively addressed in prospective studies. Contrary to the IHC stains, histopathological Dallas criteria and PCR analysis provided limited contribution to a positive diagnosis of myocarditis. The large panel of IHC stains used in our study probably led to the high percentage of positive diagnoses compared to other EMB studies, which highlights the increasing importance of IHC stains for the diagnosis of myocarditis. On the other hand, change in clinical management due to EMB was relatively low compared to other studies, which raises questions about the clinical utility of the procedure.

Item Type:	Thesis (Thesis)
Supervisor name:	Supervisor: and Meye rDr. med. Sven, (Faculty Supervisor) and Department: Klinik für Kardiologie, Klinikum Oldenburg(D)
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:52
Last Modified:	25 Jun 2020 10:52
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1329

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