Myocardial Biopsy: Diagnostic Significance

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The diagnostic and therapeutic value of this procedure, its safety and the choice of the ventricular side left versus right of EMB are still a matter for discussion. Previous retrospective studies have shown that the use of biventricular EMB was associated with a higher diagnostic yield compared to selective univentricular EMB 1, 2. The study of Stiermaier et al.

A total of patients with suspected myocarditis were investigated. The suspicion of myocarditis was based on symptoms suggesting inflammatory heart disease e.

Biventricular EMB was performed in patients. In case of chronic myocarditis formerly called borderline myocarditis , acute myocyte injury could not be detected, but inflammation and interstitial fibrosis became evident. All EMB were tested for viral genome by nested reverse transcriptase- polymerase chain reaction.

The value of endomyocardial biopsy in diagnosis and guiding therapy.

Evidence of viral genomes in the absence of inflammation was diagnosed as latent virus persistence. Dilated cardiomyopathy was primarily diagnosed in association with additional angiographic and CMR data. Out of the investigated patients with suspected myocarditis, in 4 patients LV-EMB was not performed in 3 patients due to left ventricle thrombus and in 1 patient due to pericardial tamponade, which occurred during RV-EMB.

A median of 6 samples were taken from each ventricle. Out of RV-EMB, one major complication occurred pericardial tamponade requiring surgical revision corresponding to a major complication rate of 0.

During left ventricular biopsy, no major but two minor complications supraventricular arrhythmia, atrioventricular block were documented. Myocarditis was diagnosed in 97 patients While 67 patients In 37 of 38 patients with the final diagnosis other than myocarditis, LV- and RV-EMB demonstrated similar results which led to a congruent diagnosis.

A latent virus persistence without myocardial inflammation was shown in 9.

Hypertrophic cardiomyopathy was documented in 2 patients and an amyloidosis in one subject. In 2 patients 1.

This prospective study shows that biventricular EMB performed by experienced interventionalists is a safe procedure with a low complication rate. The non-invasive diagnosis of myocarditis and other infiltrative or storage cardiac diseases, such as amyloidosis can be challenging.

Diagnostic endomyocardial biopsy – still useful after all these years

The present prospective study of Stiermeier et al. These results are in line with the retrospective study by Yilmaz et al.

Presence of myocarditis was detected in Considering also other cardiac diseases as amyloidosis, sarcoidosis as well as hypertrophic und restrictive cardiomyopathy, diagnostic EMB results were achieved significantly more often in patients with biventricular EMB Correct patient selection and the quantity of tissue samples impart a significant influence on the accuracy of the diagnosis, and thus the value of EMB is variable for each patient. The purpose of this study was to evaluate the role of EMB in patient care, through its ability to either change clinical diagnosis or alter patient management.

Our study was based in a single teaching centre. An audit of cardiac biopsies performed over a 10 year period identified patients. We assessed indications, histology, electron microscopic findings, final clinical diagnosis and how they influenced patient management.

A definite diagnosis on histology was given in 44 of patients Non-specific findings were observed in the remaining patients Histology influenced patient management in 73 Histological examination in the remaining biopsies It was additionally found that the number of tissue fragments sampled has significant impact on diagnostic accuracy.

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