Clinical merit of endomyocardial biopsy.

Abstract

At this time, endomyocardial biopsy has proven validity as a diagnostic method in few circumstances. However, it is overused. In the near term, the extent of its use should be modified by knowledge of its therapeutic relevance in patients with myocarditis. In the long term, numerous new techniques for studying pathophysiology at the subcellular and molecular levels will demand a central role for endomyocardial biopsy in the diagnosis, treatment and fundamental understanding of myocardial diseases. We believe that endomyocardial biopsy will serve as an indispensible link between basic scientists and clinicians in the effort to describe disease mechanisms.

The Role of Endomyocardial Biopsy in the Management of Cardiovascular Disease

“…One authoritative review questioned the "strikingly high" incidence of reported histological myocardial abnormalities in the literature, and the review authors comment that they suspect the true incidence of abnormalities described in these reports to be lower. 136 Notably, biopsy is not believed to be able to detect abnormalities that are present in only the conduction system. 137 Hosenpud et al 138 reported that in 10 patients with lifethreatening arrhythmias in the absence of structural heart disease, EMB demonstrated lymphocytic myocarditis in 2 patients, granulomatous myocarditis in 2 patients, and smallvessel vasculitis in 1 patient.…”

The Role of Endomyocardial Biopsy in the Management of Cardiovascular Disease

“…One authoritative review questioned the "strikingly high" incidence of reported histological myocardial abnormalities in the literature, and the review authors comment that they suspect the true incidence of abnormalities described in these reports to be lower (136). Notably, biopsy is not believed to be able to detect abnormalities that are present in only the conduction system (137).…”

Clinical Profile and Outcome of Idiopathic Restrictive Cardiomyopathy

“…Furthermore, myocardial biopsy should be considered in patients with a suspected secondary form of restrictive heart muscle disease, such as amyloidosis, hemochromatosis, sarcoidosis, or hypereosinophilic syndrome. 13,28,29 This is especially true in the presence of suggestive findings, such as increased wall thickness on echocardiography, low voltage on ECG, high eosinophil count, or the presence of systemic manifestations of the disease. None of these were present in our patient population.…”