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The discrepancies between clinical and histopathological diagnoses of cardiomyopathies in patients with stage D heart failure undergoing heart transplantation

BACKGROUND: This study aimed to determine the etiology of stage-D heart failure (HF) and the prevalence and prognosis of misdiagnosed cardiomyopathy in patients undergoing heart transplantation. METHODS AND RESULTS: We retrospectively reviewed 127 consecutive patients (mean age, 42 years; 90 [71%],...

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Autores principales: Lertsuttimetta, Thana, Tumkosit, Monravee, Kaveevorayan, Peerapat, Chantranuwatana, Poonchavist, Theerasuwipakorn, Nonthikorn, Chattranukulchai, Pairoj, Puwanant, Sarinya
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9159581/
https://www.ncbi.nlm.nih.gov/pubmed/35648762
http://dx.doi.org/10.1371/journal.pone.0269019
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author Lertsuttimetta, Thana
Tumkosit, Monravee
Kaveevorayan, Peerapat
Chantranuwatana, Poonchavist
Theerasuwipakorn, Nonthikorn
Chattranukulchai, Pairoj
Puwanant, Sarinya
author_facet Lertsuttimetta, Thana
Tumkosit, Monravee
Kaveevorayan, Peerapat
Chantranuwatana, Poonchavist
Theerasuwipakorn, Nonthikorn
Chattranukulchai, Pairoj
Puwanant, Sarinya
author_sort Lertsuttimetta, Thana
collection PubMed
description BACKGROUND: This study aimed to determine the etiology of stage-D heart failure (HF) and the prevalence and prognosis of misdiagnosed cardiomyopathy in patients undergoing heart transplantation. METHODS AND RESULTS: We retrospectively reviewed 127 consecutive patients (mean age, 42 years; 90 [71%], male) from February 1994 to September 2021 admitted for heart transplant in our tertiary center. Pre-transplant clinical diagnosis was compared with post-transplant pathological diagnosis. The most common misdiagnosed cardiomyopathy was nonischemic cardiomyopathy accounting for 6% (n = 8) of all patients. Histopathological examination of explanted hearts in misdiagnosed patients revealed 2 arrhythmogenic cardiomyopathy, 2 sarcoidosis, 1 hypertrophic cardiomyopathy, 1 hypersensitivity myocarditis, 1 noncompacted cardiomyopathy, and 1 ischemic cardiomyopathy. Pre-transplant cardiac MRI and endomyocardial biopsy (EMB) were performed in 33 (26%) and 6 (5%) patients, respectively, with both performed in 3 (3% of patients). None of the patients undergoing both cardiac tests were misdiagnosed. During the 5-years follow-up period, 2 (25%) and 44 (37%) patients with and without pretransplant misdiagnosed cardiomyopathy died. There was no difference in survival rate between the groups (hazard ratio: 0.52; 95% CI:0.11–2.93; P = 0.314). CONCLUSIONS: The prevalence of misdiagnosed cardiomyopathy was 6% of patients with stage-D HF undergoing heart transplantation, the misdiagnosis mostly occurred in nonischemic/dilated cardiomyopathy. An accurate diagnosis of newly detected cardiomyopathy gives an opportunity for potentially reversing cardiomyopathy, including sarcoidosis or myocarditis. This strategy may minimize the need for advanced HF therapy or heart transplantation. With advances in cardiac imaging, improvements in diagnostic accuracy of the etiology of HF can improve targeting of treatment.
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spelling pubmed-91595812022-06-02 The discrepancies between clinical and histopathological diagnoses of cardiomyopathies in patients with stage D heart failure undergoing heart transplantation Lertsuttimetta, Thana Tumkosit, Monravee Kaveevorayan, Peerapat Chantranuwatana, Poonchavist Theerasuwipakorn, Nonthikorn Chattranukulchai, Pairoj Puwanant, Sarinya PLoS One Research Article BACKGROUND: This study aimed to determine the etiology of stage-D heart failure (HF) and the prevalence and prognosis of misdiagnosed cardiomyopathy in patients undergoing heart transplantation. METHODS AND RESULTS: We retrospectively reviewed 127 consecutive patients (mean age, 42 years; 90 [71%], male) from February 1994 to September 2021 admitted for heart transplant in our tertiary center. Pre-transplant clinical diagnosis was compared with post-transplant pathological diagnosis. The most common misdiagnosed cardiomyopathy was nonischemic cardiomyopathy accounting for 6% (n = 8) of all patients. Histopathological examination of explanted hearts in misdiagnosed patients revealed 2 arrhythmogenic cardiomyopathy, 2 sarcoidosis, 1 hypertrophic cardiomyopathy, 1 hypersensitivity myocarditis, 1 noncompacted cardiomyopathy, and 1 ischemic cardiomyopathy. Pre-transplant cardiac MRI and endomyocardial biopsy (EMB) were performed in 33 (26%) and 6 (5%) patients, respectively, with both performed in 3 (3% of patients). None of the patients undergoing both cardiac tests were misdiagnosed. During the 5-years follow-up period, 2 (25%) and 44 (37%) patients with and without pretransplant misdiagnosed cardiomyopathy died. There was no difference in survival rate between the groups (hazard ratio: 0.52; 95% CI:0.11–2.93; P = 0.314). CONCLUSIONS: The prevalence of misdiagnosed cardiomyopathy was 6% of patients with stage-D HF undergoing heart transplantation, the misdiagnosis mostly occurred in nonischemic/dilated cardiomyopathy. An accurate diagnosis of newly detected cardiomyopathy gives an opportunity for potentially reversing cardiomyopathy, including sarcoidosis or myocarditis. This strategy may minimize the need for advanced HF therapy or heart transplantation. With advances in cardiac imaging, improvements in diagnostic accuracy of the etiology of HF can improve targeting of treatment. Public Library of Science 2022-06-01 /pmc/articles/PMC9159581/ /pubmed/35648762 http://dx.doi.org/10.1371/journal.pone.0269019 Text en © 2022 Lertsuttimetta et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Lertsuttimetta, Thana
Tumkosit, Monravee
Kaveevorayan, Peerapat
Chantranuwatana, Poonchavist
Theerasuwipakorn, Nonthikorn
Chattranukulchai, Pairoj
Puwanant, Sarinya
The discrepancies between clinical and histopathological diagnoses of cardiomyopathies in patients with stage D heart failure undergoing heart transplantation
title The discrepancies between clinical and histopathological diagnoses of cardiomyopathies in patients with stage D heart failure undergoing heart transplantation
title_full The discrepancies between clinical and histopathological diagnoses of cardiomyopathies in patients with stage D heart failure undergoing heart transplantation
title_fullStr The discrepancies between clinical and histopathological diagnoses of cardiomyopathies in patients with stage D heart failure undergoing heart transplantation
title_full_unstemmed The discrepancies between clinical and histopathological diagnoses of cardiomyopathies in patients with stage D heart failure undergoing heart transplantation
title_short The discrepancies between clinical and histopathological diagnoses of cardiomyopathies in patients with stage D heart failure undergoing heart transplantation
title_sort discrepancies between clinical and histopathological diagnoses of cardiomyopathies in patients with stage d heart failure undergoing heart transplantation
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9159581/
https://www.ncbi.nlm.nih.gov/pubmed/35648762
http://dx.doi.org/10.1371/journal.pone.0269019
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