{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T20:52:38Z","timestamp":1769115158136,"version":"3.49.0"},"reference-count":46,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,1,19]],"date-time":"2026-01-19T00:00:00Z","timestamp":1768780800000},"content-version":"vor","delay-in-days":2811,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2018,5,10]],"date-time":"2018-05-10T00:00:00Z","timestamp":1525910400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002347","name":"Bundesministerium f\u00fcr Bildung und Forschung","doi-asserted-by":"publisher","award":["01EO1503"],"award-info":[{"award-number":["01EO1503"]}],"id":[{"id":"10.13039\/501100002347","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Center for Translational Vascular Biology (CTVB), University Medical Center Mainz"},{"DOI":"10.13039\/501100002347","name":"Bundesministerium f\u00fcr Bildung und Forschung","doi-asserted-by":"publisher","award":["01EO1503"],"award-info":[{"award-number":["01EO1503"]}],"id":[{"id":"10.13039\/501100002347","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2018,8,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Aetiology of heart failure (HF) often remains obscure. We therefore evaluated the usefulness of a combined diagnostic approach including cardiac magnetic resonance imaging (CMRI) and endomyocardial biopsy (EMB) to assess the cause of unexplained cardiomyopathy underlying HF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>We retrospectively investigated 100 consecutive patients (36% women, mean age 53.6 \u00b1 18.8 years) presenting with unexplained cardiomyopathy (HF with reduced ejection fraction or left ventricular hypertrophy; excluding ischaemic and valvular heart disease; left ventricular ejection fraction 31.6 \u00b1 13.9%, Left ventricular end-diastolic pressure 18.2 \u00b1 9.3 mmHg, heart rate 89 \u00b1 26.6 b.p.m.; mean \u00b1 SEM) at the University Medical Center Mainz. We performed electrocardiography, echocardiography, CMRI, and cardiac catheterization with EMB analysed at a Food and Drug Administration-approved reference centre in 100%, 94%, 69%, and 100% of patients, respectively. On the basis of CMRI findings, electrocardiography, echocardiography, and medical history, the exact cause of cardiomyopathy remained uncertain in 37 of 69 cases (53.6%). In EMB, 25% of patients had viral replication, 23% had inflammation defined as lymphocytic infiltrations without active virus replication, 1% had giant cell myocarditis, and 1% had eosinophilic myocarditis. After diagnostic workup including EMB findings, the cause of cardiomyopathy remained unidentified in 14% of the cases, classified as idiopathic dilated cardiomyopathy or hypertrophic cardiomyopathy in 10% or 4%, respectively. EMB helped to discuss a causal treatment strategy of HF involving immunosuppression or antiviral treatment in 53% of patients, which was opted for in 12% of the patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>A comprehensive workup including imaging and EMB in an all-comer population of patients with HF may help physicians to improve diagnostics of unexplained cardiomyopathy in the majority of cases.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ehf2.12296","type":"journal-article","created":{"date-parts":[[2018,5,10]],"date-time":"2018-05-10T06:14:47Z","timestamp":1525932887000},"page":"630-641","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Therapeutic Implications of a Combined Diagnostic Workup Including Endomyocardial Biopsy in an All-Comer Population of Patients with Heart Failure: A Retrospective Analysis"],"prefix":"10.1093","volume":"5","author":[{"given":"Efthymios","family":"Sotiriou","sequence":"first","affiliation":[{"name":"Center for Cardiology, Cardiology 1, University Medical Center Mainz , Langenbeckstr. 1, 55131, Mainz ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Susanne","family":"Heiner","sequence":"additional","affiliation":[{"name":"Center for Cardiology, Cardiology 1, University Medical Center Mainz , Langenbeckstr. 1, 55131, Mainz ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Jansen","sequence":"additional","affiliation":[{"name":"Center for Cardiology, Cardiology 1, University Medical Center Mainz , Langenbeckstr. 1, 55131, Mainz ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Moritz","family":"Brandt","sequence":"additional","affiliation":[{"name":"Center for Cardiology, Cardiology 1, University Medical Center Mainz , Langenbeckstr. 1, 55131, Mainz ,","place":["Germany"]},{"name":"German Center for Cardiovascular Research (DZHK), partner site Rhine-Main , Berlin ,","place":["Germany"]},{"name":"Center for Thrombosis and Hemostasis, University Medical Center Mainz , Langenbeckstr. 1, 55131, Mainz ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kai Helge","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Center for Cardiology, Cardiology 1, University Medical Center Mainz , Langenbeckstr. 1, 55131, Mainz ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karl-Friedrich","family":"Kreitner","sequence":"additional","affiliation":[{"name":"Clinic for Diagnostic and Interventional Radiology, University Medical Center Mainz , Langenbeckstr. 1, 55131, Mainz ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tilman","family":"Emrich","sequence":"additional","affiliation":[{"name":"Clinic for Diagnostic and Interventional Radiology, University Medical Center Mainz , Langenbeckstr. 1, 55131, Mainz ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Heinz-Peter","family":"Schultheiss","sequence":"additional","affiliation":[{"name":"IKDT Institut Kardiale Diagnostik und Therapie GmbH , Moltkestra\u00dfe 31, 12203, Berlin ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eberhard","family":"Schulz","sequence":"additional","affiliation":[{"name":"Center for Cardiology, Cardiology 1, University Medical Center Mainz , Langenbeckstr. 1, 55131, Mainz ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"M\u00fcnzel","sequence":"additional","affiliation":[{"name":"Center for Cardiology, Cardiology 1, University Medical Center Mainz , Langenbeckstr. 1, 55131, Mainz ,","place":["Germany"]},{"name":"German Center for Cardiovascular Research (DZHK), partner site Rhine-Main , Berlin ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip","family":"Wenzel","sequence":"additional","affiliation":[{"name":"Center for Cardiology, Cardiology 1, University Medical Center Mainz , Langenbeckstr. 1, 55131, Mainz ,","place":["Germany"]},{"name":"German Center for Cardiovascular Research (DZHK), partner site Rhine-Main , Berlin ,","place":["Germany"]},{"name":"Center for Thrombosis and Hemostasis, University Medical Center Mainz , Langenbeckstr. 1, 55131, Mainz 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