{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,2]],"date-time":"2025-11-02T06:11:36Z","timestamp":1762063896218,"version":"build-2065373602"},"reference-count":44,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2022,8,21]],"date-time":"2022-08-21T00:00:00Z","timestamp":1661040000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Objective: The study objective is assessing findings and outcome in children with suspected cardiomyopathy (CMP) or myocarditis undergoing cardiac catheterization with transcatheter right ventricular endomyocardial biopsy (RV-EMB). Methods: All consecutive children undergoing cardiac catheterization with RV-EMB for suspected CMP\/myocarditis between 2002\u20132021 were analysed regarding clinical presentation, cardiac biomarkers, periprocedural management, hemodynamic, histological\/immunohistological findings, and outcome. Results: Eighty-five RV-EMBs were performed in 81 patients at a median age of 6.8 (IQR 9.9) years and a bodyweight of 20 (32.2) kg. Histological\/immunohistological findings of RV-EMB revealed dilated CMP in 10 (12%), chronic myocarditis in 28 (33%), healing myocarditis in 5 (6%), acute myocarditis in 9 (11%), other heart muscle diseases in 23 (27%) (7 restrictive CMP, 5 hypertrophic CMP, 4 toxic\/anthracycline-induced CMP, 4 endocardfibroelastosis, 1 arrhythmogenic right ventricular CMP, 1 laminin CMP, 1 haemangioma), no conclusive histology in 7 (8%), and normal histology in 3 (4%) patients. Median LVEDP was 17 mmHg (IQR 9), LAP 15 mmHg (10), and PVR 1.83 (1.87) Wood Units\/m2. There were 3 major complications (3%), all patients recovered without any sequelae. At follow-up (median 1153, IQR 1799 days) 47 (59%) patients were alive, 11 (13%) dead, 15 (18%) underwent cardiac transplantation, and 8 (9%) were lost to follow-up. Death\/cardiac transplantation occurred within 3 years from RV-EMB. All patients with an acute myocarditis survived. NT-pro-BNP, echo parameters, and invasive hemodynamics correlate independently with death\/cardiac transplant. Conclusion: Hemodynamic invasive data and morphological findings in RV-EMB complete clinical diagnosis in children with suspected CMP\/myocarditis and provide important information for further clinical management.<\/jats:p>","DOI":"10.3390\/ijerph191610406","type":"journal-article","created":{"date-parts":[[2022,8,21]],"date-time":"2022-08-21T22:23:13Z","timestamp":1661120593000},"page":"10406","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Findings and Outcome of Transcatheter Right Ventricular Endomyocardial Biopsy and Hemodynamic Assessment in Children with Suspected Myocarditis or Cardiomyopathy"],"prefix":"10.3390","volume":"19","author":[{"given":"Alessia","family":"Callegari","sequence":"first","affiliation":[{"name":"Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children\u2019s Hospital Zurich, 8032 Zurich, Switzerland"},{"name":"Children\u2019s Research Centre, University Children\u2019s Hospital Zurich, 8032 Zurich, Switzerland"},{"name":"University of Zurich, 8006 Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Quandt","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children\u2019s Hospital Zurich, 8032 Zurich, Switzerland"},{"name":"Children\u2019s Research Centre, University Children\u2019s Hospital Zurich, 8032 Zurich, Switzerland"},{"name":"University of Zurich, 8006 Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Achim","family":"Schmitz","sequence":"additional","affiliation":[{"name":"Children\u2019s Research Centre, University Children\u2019s Hospital Zurich, 8032 Zurich, Switzerland"},{"name":"University of Zurich, 8006 Zurich, Switzerland"},{"name":"Division of Anesthesia, University Children\u2019s Hospital Zurich, 8032 Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0203-2498","authenticated-orcid":false,"given":"Karin","family":"Klingel","sequence":"additional","affiliation":[{"name":"Cardiopathology, Institute for Pathology, Eberhard Karls University T\u00fcbingen, 72074 Tubingen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1358-3535","authenticated-orcid":false,"given":"Christian","family":"Balmer","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children\u2019s Hospital Zurich, 8032 Zurich, Switzerland"},{"name":"Children\u2019s Research Centre, University Children\u2019s Hospital Zurich, 8032 Zurich, Switzerland"},{"name":"University of Zurich, 8006 Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hitendu","family":"Dave","sequence":"additional","affiliation":[{"name":"Children\u2019s Research Centre, University Children\u2019s Hospital Zurich, 8032 Zurich, Switzerland"},{"name":"University of Zurich, 8006 Zurich, Switzerland"},{"name":"Congenital Cardiovascular Surgery, Pediatric Heart Center, Department of Surgery, University Children\u2019s Hospital Zurich, 8032 Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6635-2610","authenticated-orcid":false,"given":"Oliver","family":"Kretschmar","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children\u2019s Hospital Zurich, 8032 Zurich, Switzerland"},{"name":"Children\u2019s Research Centre, University Children\u2019s Hospital Zurich, 8032 Zurich, Switzerland"},{"name":"University of Zurich, 8006 Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8741-3929","authenticated-orcid":false,"given":"Walter","family":"Knirsch","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology, Pediatric Heart Center, Department of Surgery, University Children\u2019s Hospital Zurich, 8032 Zurich, Switzerland"},{"name":"Children\u2019s Research Centre, University Children\u2019s Hospital Zurich, 8032 Zurich, Switzerland"},{"name":"University of Zurich, 8006 Zurich, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,8,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1161\/CIRCOUTCOMES.112.965749","article-title":"Demographics, trends, and outcomes in pediatric acute myocarditis in the United States, 2006 to 2011","volume":"5","author":"Ghelani","year":"2012","journal-title":"Circ. Cardiovasc. Qual. Outcomes"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1281","DOI":"10.1016\/j.pcl.2010.09.012","article-title":"Myocarditis and Pericarditis in Children","volume":"57","author":"Durani","year":"2010","journal-title":"Pediatr. Clin. N. Am."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1007\/s11886-018-1054-z","article-title":"Acute and Fulminant Myocarditis: A Pragmatic Clinical Approach to Diagnosis and Treatment","volume":"20","author":"Ammirati","year":"2018","journal-title":"Curr. Cardiol. Rep."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Ammirati, E., Veronese, G., Bottiroli, M., Wang, D.W., Cipriani, M., Garascia, A., Pedrotti, P., Adler, E.D., and Frigerio, M. (Trends Cardiovasc. Med., 2020). Update on Acute Myocarditis, Trends Cardiovasc. Med., Epub ahead of print.","DOI":"10.1016\/j.tcm.2020.05.008"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"548","DOI":"10.12998\/wjcc.v7.i5.548","article-title":"Clinical presentation and early predictors for poor outcomes in pediatric myocarditis: A retrospective study","volume":"7","year":"2019","journal-title":"World J. Clin. Cases"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1016\/j.ijcard.2019.12.039","article-title":"Resident inflammatory cells in the myocardium of children: On the way to set histologic reference standards to differentiate normal myocardium from myocarditis","volume":"303","author":"Ammirati","year":"2020","journal-title":"Int. J. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"638","DOI":"10.1016\/j.jpeds.2010.10.015","article-title":"Management and outcomes in pediatric patients presenting with acute fulminant myocarditis","volume":"158","author":"Teele","year":"2011","journal-title":"J. Pediatr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"115","DOI":"10.1161\/CIRCULATIONAHA.113.001372","article-title":"Diagnosis and treatment of myocarditis in children in the current era","volume":"129","author":"Canter","year":"2014","journal-title":"Circulation"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1161\/CIRCULATIONAHA.117.028895","article-title":"Long-Term Outcomes of Hypertrophic Cardiomyopathy Diagnosed During Childhood: Results From a National Population-Based Study","volume":"138","author":"Alexander","year":"2018","journal-title":"Circulation"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1222","DOI":"10.1253\/circj.CJ-11-1032","article-title":"Comparison of the Clinical Presentation, Treatment, and Outcome of Fulminant and Acute Myocarditis in Children","volume":"76","author":"Saji","year":"2012","journal-title":"Circ. J."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1016\/j.pedneo.2017.01.001","article-title":"Pediatric Heart Failure: A Practical Guide to Diagnosis and Management","volume":"58","author":"Masarone","year":"2017","journal-title":"Pediatr. Neonatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2636","DOI":"10.1093\/eurheartj\/eht210","article-title":"Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: A position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases","volume":"34","author":"Caforio","year":"2013","journal-title":"Eur. Heart J."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1581","DOI":"10.1161\/CIRCULATIONAHA.105.606509","article-title":"Presentation, patterns of myocardial damage, and clinical course of viral myocarditis","volume":"114","author":"Mahrholdt","year":"2006","journal-title":"Circulation"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/pin.12868","article-title":"Inflammation in myocardial disease: From myocarditis to dilated cardiomyopathy","volume":"70","year":"2020","journal-title":"Pathol. Int."},{"key":"ref_15","first-page":"4270","article-title":"Endomyocardial biopsy in patients with acute myocarditis, idiopathic dilated cardiomyopathy, and arrhythmogenic right ventricular dysplasia","volume":"11","author":"Li","year":"2018","journal-title":"Int. J. Clin. Exp. Pathol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"2105","DOI":"10.1016\/S0735-1097(99)00452-0","article-title":"Complications of endomyocardial biopsy in children","volume":"34","author":"Pophal","year":"1999","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1017\/S1047951103000866","article-title":"Safety of endomyocardial biopsy in children","volume":"13","author":"Cowley","year":"2003","journal-title":"Cardiol. Young"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"762","DOI":"10.1002\/ccd.26319","article-title":"Endomyocardial biopsy safety and clinical yield in pediatric myocarditis: An Italian perspective","volume":"87","author":"Brighenti","year":"2016","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1136\/hrt.72.4.360","article-title":"Role of right ventricular endomyocardial biopsy in infants and children with suspected or possible myocarditis","volume":"72","author":"Webber","year":"1994","journal-title":"Br. Heart J."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1478","DOI":"10.1007\/s00246-017-1688-4","article-title":"Regression of Neonatal Cardiac Rhabdomyoma in Two Months Through Low-Dose Everolimus Therapy: A Report of Three Cases","volume":"38","author":"Chang","year":"2017","journal-title":"Pediatr. Cardiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"922","DOI":"10.1016\/j.echo.2008.02.006","article-title":"Regression equations for calculation of z scores of cardiac structures in a large cohort of healthy infants, children, and adolescents: An echocardiographic study","volume":"21","author":"Pettersen","year":"2008","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"639","DOI":"10.1161\/CIRCULATIONAHA.108.769489","article-title":"Predictors of outcome in patients with suspected myocarditis","volume":"118","author":"Kindermann","year":"2008","journal-title":"Circulation"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"841","DOI":"10.1161\/01.CIR.93.5.841","article-title":"Report of the 1995 World Health Organization\/International Society and Federation of Cardiology Task Force on the Definition and Classification of cardiomyopathies","volume":"93","author":"Richardson","year":"1996","journal-title":"Circulation"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"513","DOI":"10.1016\/j.jcmg.2011.11.022","article-title":"Diagnostic Performance of CMR Imaging Compared With RV-EMB in Patients With Suspected Myocarditis","volume":"5","author":"Lurz","year":"2012","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2869","DOI":"10.1093\/eurheartj\/ehp328","article-title":"Diagnostic synergy of non-invasive cardiovascular magnetic resonance and invasive endomyocardial biopsy in troponin-positive patients without coronary artery disease","volume":"30","author":"Baccouche","year":"2009","journal-title":"Eur. Heart J."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1248","DOI":"10.1056\/NEJMc0911362","article-title":"Human parvovirus B19-associated myocarditis","volume":"362","author":"Bock","year":"2010","journal-title":"N. Engl. J. Med."},{"key":"ref_27","unstructured":"Mueller, G.C., Michel-Behnke, I., Knirsch, W., Haas, N.A., Abdul-Khaliq, H., and Gitter, R. (2022, August 04). Feasibility, Safety and Diagnostic Impact of Endomyocardial Biopsies for the Diagnosis of Myocardial Disease in Children and Adolescents [Internet]. EuroIntervention. Available online: https:\/\/eurointervention.pcronline.com\/article\/feasibility-safety-and-diagnostic-impact-of-endomyocardial-biopsies-for-the-diagnosis-of-myocardial-disease-in-children-and-adolescents."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1034\/j.1399-3046.2000.00100.x","article-title":"Endomyocardial biopsy in pediatric heart transplant recipients: A useful exercise? (Analysis of 1169 biopsies)","volume":"4","author":"Wagner","year":"2000","journal-title":"Pediatr. Transplant."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1016\/j.healun.2011.11.019","article-title":"Endomyocardial biopsy and selective coronary angiography are low-risk procedures in pediatric heart transplant recipients: Results of a multicenter experience","volume":"31","author":"Daly","year":"2012","journal-title":"J. Heart Lung Transplant."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1007\/s00246-013-0807-0","article-title":"Role of endomyocardial biopsy for children presenting with acute systolic heart failure","volume":"35","author":"Das","year":"2014","journal-title":"Pediatr. Cardiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2009","DOI":"10.1161\/CIRCULATIONAHA.117.027714","article-title":"Modeling Major Adverse Outcomes of Pediatric and Adult Patients With Congenital Heart Disease Undergoing Cardiac Catheterization: Observations From the NCDR IMPACT Registry (National Cardiovascular Data Registry Improving Pediatric and Adult Congenital Treatment)","volume":"136","author":"Jayaram","year":"2017","journal-title":"Circulation"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1722","DOI":"10.1161\/CIRCULATIONAHA.107.743427","article-title":"Complication Rate of Right Ventricular Endomyocardial Biopsy via the Femoral Approach: A Retrospective and Prospective Study Analyzing 3048 Diagnostic Procedures Over an 11-Year Period","volume":"118","author":"Holzmann","year":"2008","journal-title":"Circulation"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1161\/CIRCHEARTFAILURE.109.902833","article-title":"Ventricular remodeling and survival are more favorable for myocarditis than for idiopathic dilated cardiomyopathy in childhood: An outcomes study from the Pediatric Cardiomyopathy Registry","volume":"3","author":"Foerster","year":"2010","journal-title":"Circ. Heart Fail."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1261","DOI":"10.1016\/j.healun.2009.06.019","article-title":"Routine performance of endomyocardial biopsy decreases the incidence of orthotopic heart transplant for myocarditis","volume":"28","author":"Hill","year":"2009","journal-title":"J. Heart Lung Transplant."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1161\/CIRCULATIONAHA.110.011999","article-title":"Early Predictors of Survival to and After Heart Transplantation in Children with Dilated Cardiomyopathy","volume":"126","author":"Pietra","year":"2012","journal-title":"Circulation"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1016\/j.amjcard.2014.11.029","article-title":"Analysis of clinical parameters and cardiac magnetic resonance imaging as predictors of outcome in pediatric myocarditis","volume":"115","author":"Sachdeva","year":"2015","journal-title":"Am. J. Cardiol."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1001","DOI":"10.1016\/S0025-6196(11)60670-8","article-title":"Diagnosis and Treatment of Viral Myocarditis","volume":"84","author":"Schultz","year":"2009","journal-title":"Mayo Clin. Proc."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1016\/j.ahj.2005.03.037","article-title":"Survival in biopsy-proven myocarditis: A long-term retrospective analysis of the histopathologic, clinical, and hemodynamic predictors","volume":"151","author":"Magnani","year":"2006","journal-title":"Am. Heart J."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1638","DOI":"10.1007\/s00246-019-02198-w","article-title":"What is the Significance of Elevated Troponin I in Children and Adolescents? A Diagnostic Approach","volume":"40","year":"2019","journal-title":"Pediatr. Cardiol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"314","DOI":"10.1136\/hrt.2008.151639","article-title":"Biomarkers in heart failure","volume":"96","author":"Chen","year":"2010","journal-title":"Heart"},{"key":"ref_41","first-page":"SC12","article-title":"Predictors of Mortality in Paediatric Myocarditis","volume":"10","author":"Abrar","year":"2016","journal-title":"J. Clin. Diagn Res."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1002\/clc.20075","article-title":"Troponin, B-type natriuretic peptides and outcomes in severe heart failure: Differences between ischemic and dilated cardiomyopathies","volume":"30","author":"Miller","year":"2007","journal-title":"Clin Cardiol."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Noori, N.M., Mahjoubifard, M., Shahramian, I., Teimouri, A., and Jahangirifard, A. (2015). Comparison between procalcitonin, brain natriuretic peptide, and uric acid in children with cardiomyopathy and controls. Biomed. Res. Int., 2015.","DOI":"10.1155\/2015\/510450"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"e374","DOI":"10.1097\/MPH.0000000000002156","article-title":"Advanced Imaging and New Cardiac Biomarkers in Long-term Follow-up After Childhood Cancer","volume":"44","author":"Sitte","year":"2021","journal-title":"J. Pediatr. Hematol. Oncol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/16\/10406\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:13:08Z","timestamp":1760141588000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/16\/10406"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,8,21]]},"references-count":44,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2022,8]]}},"alternative-id":["ijerph191610406"],"URL":"https:\/\/doi.org\/10.3390\/ijerph191610406","relation":{},"ISSN":["1660-4601"],"issn-type":[{"type":"electronic","value":"1660-4601"}],"subject":[],"published":{"date-parts":[[2022,8,21]]}}}