{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T19:50:03Z","timestamp":1773431403533,"version":"3.50.1"},"reference-count":56,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2026,2,18]],"date-time":"2026-02-18T00:00:00Z","timestamp":1771372800000},"content-version":"vor","delay-in-days":152,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T00:00:00Z","timestamp":1758240000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>The need to perform endomyocardial biopsy (EMB) in patients with non-ischaemic dilated cardiomyopathies (DCM) is debated. Here we sought to determine the extent of left ventricular collagen volume fraction (LV-CVF) in DCM patients and to evaluate it as a prognostic marker.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>In this retrospective longitudinal study, we included 524 patients with suspected DCM who underwent left ventricular EMB (LV-EMB) as a part of their clinical work-up. LV-CVF was quantified using automated image processing of high-resolution scans of LV-EMB. Deep phenotyping was performed including assessment of late gadolinium enhancement on cardiac magnetic resonance imaging. Endpoints were (i) composite endpoint of heart failure-related death, sudden cardiac death, aborted sudden cardiac death (appropriate implantable cardioverter-defibrillator shock, reported sustained ventricular tachycardia, or cardiopulmonary resuscitation), or cardiac transplantation, and (ii) all-cause mortality. LV-EMB was associated with 0.76% major and 2.1% minor complications. No death occurred due to EMB. LV-CVF could be reliably quantified using Bayesian classification. During a median follow-up of 43.2\u2009months (2084 patient-years), 48 patients with LV-CVF &amp;gt;32% and 14 patients with LV-CVF \u226432% reached the composite endpoint (log-rank p\u2009&amp;lt;\u20090.0001). A total of 62 patients reached the endpoint all-cause mortality, from which 38 presented with LV-CVF &amp;gt;32% and 17 with LV-CVF \u226432% (log-rank p\u2009=\u20090.009). In multivariable analyses, LV-CVF and N-terminal pro-B-type natriuretic peptide (NT-proBNP) (hazard ratio 2.03, 95% confidence interval 1.32\u20133.11) were independent predictors of unfavourable outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Left ventricular EMB is a safe diagnostic procedure. The extent of CVF in LV-EMB provides prognostic information in patients with DCM in addition to existing measures of left ventricular ejection fraction or NT-proBNP.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ejhf.70019","type":"journal-article","created":{"date-parts":[[2025,9,19]],"date-time":"2025-09-19T08:29:31Z","timestamp":1758270571000},"page":"3029-3039","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Safety and Prognostic Value of Left Ventricular Endomyocardial Biopsy in Dilated Cardiomyopathy"],"prefix":"10.1093","volume":"27","author":[{"given":"Elham","family":"Kayvanpour","sequence":"first","affiliation":[{"name":"Department of Medicine III, University of Heidelberg , Heidelberg ,","place":["Germany"]},{"name":"DZHK (German Centre for Cardiovascular Research) , Heidelberg 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,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali","family":"Amr","sequence":"additional","affiliation":[{"name":"Department of Medicine III, University of Heidelberg , Heidelberg ,","place":["Germany"]},{"name":"DZHK (German Centre for Cardiovascular Research) , Heidelberg ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bernd","family":"Lahrmann","sequence":"additional","affiliation":[{"name":"Hamamatsu Tissue Imaging and Analysis Center (BIOQUANT) , Heidelberg ,","place":["Germany"]},{"name":"Institute of Pathology, University Medical Center G\u00f6ttingen UMG , G\u00f6ttingen ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alan","family":"Lai","sequence":"additional","affiliation":[{"name":"Department of Medicine III, University of Heidelberg , Heidelberg ,","place":["Germany"]},{"name":"Roche Diagnostics GmbH , Mannheim ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christoph","family":"Reich","sequence":"additional","affiliation":[{"name":"Department of Medicine III, University of Heidelberg , Heidelberg ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chenyang","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Medicine III, University of Heidelberg , Heidelberg ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Esther","family":"Herpel","sequence":"additional","affiliation":[{"name":"Tissue Bank of the National Center for Tumor Diseases (NCT) , Heidelberg ,","place":["Germany"]},{"name":"Center of Clinical Pathology, Klinikum Darmstadt , Darmstadt ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Derliz","family":"Mereles","sequence":"additional","affiliation":[{"name":"Department of Medicine III, University of Heidelberg , Heidelberg ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lutz","family":"Frankenstein","sequence":"additional","affiliation":[{"name":"Department of Medicine III, University of Heidelberg , Heidelberg ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Niels","family":"Grabe","sequence":"additional","affiliation":[{"name":"Hamamatsu Tissue Imaging and Analysis Center (BIOQUANT) , Heidelberg ,","place":["Germany"]},{"name":"Institute of Pathology, University Medical Center G\u00f6ttingen UMG , G\u00f6ttingen ,","place":["Germany"]},{"name":"Tissue Bank of the National Center for Tumor Diseases (NCT) , Heidelberg ,","place":["Germany"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hugo A.","family":"Katus","sequence":"additional","affiliation":[{"name":"Department of Medicine III, University of Heidelberg , Heidelberg ,","place":["Germany"]},{"name":"DZHK (German Centre for Cardiovascular 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