The Role of Endomyocardial Biopsy in the Management of Cardiovascular Disease

Diagnosis and Treatment of Myocarditis in Children in the Current Era

“…A combined AHA/American College of Cardiology/ European Society of Cardiology statement 55 on the indications for endomyocardial biopsy does not support its routine clinical use for the diagnosis of myocarditis. Biopsy is recommended only in patients with new-onset heart failure (<2 weeks) with hemodynamic compromise with and without left ventricular dilatation; new-onset heart failure of 2 weeks' to 3 months' duration with a dilated left ventricle, ventricular arrhythmia, and high-grade atrioventricular block (Mobitz type II or third-degree atrioventricular block); or symptoms unresponsive to treatment in 1 to 2 weeks.…”

“…Acute myocarditis presenting with severe heart failure, arrhythmias, and lack of responsiveness to supportive care after 1 to 2 weeks leads to concern for giant cell myocarditis, which can be diagnosed by biopsy and has a grim prognosis, although is responsive to immunosuppression. 55 Myocarditis in children is associated with a high rate of congestive heart failure, hospitalization, intensive care unit stay, and use of inotropic support at the time of diagnosis compared with children with idiopathic dilated cardiomyopathy. 43 A recent study of hospitalized patients in the United States 77 found that nearly half of the patients required inotropic support, 37.5% required mechanical ventilation, and 7.4% required extracorporeal membrane oxygenator (ECMO) support.…”

“…Because of the potential to treat giant cell or eosinophilic myocarditis with immunosuppression, [3][4][5][6]57 endomyocardial biopsy is recommended in this situation. 55 Complete heart block is treated with pacemaker therapy, and therapy may be considered in second-degree block in entities such as giant cell myocarditis in which progressive block may occur. 57 Ventricular arrhythmias are treated by conventional guidelines.…”

Myopericarditis in a patient with hepatitis C and cryoglobulinemic renal disease

“…First, an endomyocardial biopsy was not performed because the evolving clinical scenario strongly implicated myocardial disease, the potential for sampling error (a well‐established complexity of endomyocardial biopsy 12) was substantial, and, in the absence of hemodynamic instability, the procedure was unlikely to yield information that would directly impact therapy. Second, the serum cryoglobulin assay was negative, despite high clinical suspicion.…”

Role of Left Ventricular Biopsy in the Management of Heart Disease

“…EMB is often essential for the diagnosis of allograft rejection and specific forms of native myocardial disease, including amyloidosis and giant cell myocarditis, 2 yet expert consensus for the utility of EMB in more common scenarios is lacking. For example, a 2013 position statement from the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases recommends heart biopsy be performed for all cases of suspected myocarditis, including most acute and chronic dilated cardiomyopathy.…”