Discordance between pre and post cardiac transplant diagnosis: Implications for pre- and postoperative decision making
Discordance between pre and post cardiac transplant diagnosis: Implications for pre- and postoperative decision making
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DOI：
10.1016/s1054-8807(98)00026-x
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发表时间：
1999-01-01
影响因子：
3.7
通讯作者：
Thiene, G
中科院分区：
文献类型：
--
作者：
Angelini, A;Boffa, GM;Thiene, G
对接受心脏移植的终末期患者进行正确的临床诊断可能具有重要的预后和治疗意义。帕多瓦大学对 257 名接受心脏移植的患者进行了回顾性临床病理学研究。临床与病理诊断不一致的有20例（8%）。在126名临床诊断为扩张型心肌病的患者中，最终发现7名患有缺血性心脏病（IHD）、5名心肌炎、1名致心律失常性右心室心肌病（ARVC）和1名非致密化心肌病。 87例临床诊断为IHD的患者中，3例为扩张型心肌病，1例为肉芽肿性心肌炎。临床诊断为肥厚型限制性心肌病的 10 例患者中，1 例患有 ARVC，1 例患有心脏纤维瘤。总共只有 24.5% 的患者在移植前接受了心内膜心肌活检 (EMB)，75% 的患者接受了冠状动脉造影。未进行 EMB 的患者发生了心肌炎的漏诊。对于明显扩张型心肌病患者，在进行心脏切除术之前，可能需要常规进行 EMB 和冠状动脉造影。 (C) 1998 年，爱思唯尔科学公司。
A correct clinical diagnosis in end-stage patients undergoing cardiac transplantation may have important prognostic and therapeutic implications. A retrospective clinico-pathologic study was carried out in 257 patients who had undergone cardiac transplantation at the University of Padua. A discrepancy between clinical and pathological diagnosis was found in 20 cases (8%). Among 126 patients with the clinical diagnosis of dilated cardiomyopathy, seven were found eventually to have ischemic heart disease (IHD), five myocarditis, one arrhythmogenic right ventricular cardiomyopathy (ARVC), and one non-compacted myocardium. Among the 87 patients with clinical diagnosis of IHD, three turned out to be dilated cardiomyopathy and one granulomatous myocarditis. Among the 10 patients with the clinical diagnosis of hypertrophic-restrictive cardiomyopathy, one had ARVC and one had cardiac fibroma. Altogether, only 24.5% underwent endomyocardial biopsy (EMB) and 75% coronary angiography before transplantation. Missed diagnosis of myocarditis occurred in patients in whom EMB was not carried out. EMB and coronary angiography might be indicated routinely in patients with apparent dilated cardiomyopathy, before proceeding to cardiectomy. (C) 1998 by Elsevier Science Inc.