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State-of-the-Art of Endomyocardial Biopsy on Acute Myocarditis and Chronic Inflammatory Cardiomyopathy

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Ammirati, Enrico, Buono, Andrea, Moroni, Francesco, Gigli, Lorenzo, Power, John R., Ciabatti, Michele, Garascia, Andrea, Adler, Eric D. +1 more·2022·Current Cardiology Reports
DOI 10.1007/s11886-022-01680-xPMC PMC8866555
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Abstract

Purpose of review Histologic evidence of myocardial inflammatory infiltrate not secondary to an ischemic injury is required by current diagnostic criteria to reach a definite diagnosis of myocarditis. Endomyocardial biopsy (EMB) is therefore often indicated for the diagnosis of myocarditis, although it may lack sufficient sensitivity considering the limited possibility of myocardial sampling. Improving the diagnostic yield and utility of EMB is of high priority in the fields of heart failure cardiology and myocarditis in particular. The aim of the present review is to highlight indications, strengths, and shortcomings of current EMB techniques, and discuss innovations currently being tested in ongoing clinical studies, especially in the setting of acute myocarditis and chronic inflammatory cardiomyopathy. Recent findings EMB provides unique diagnostic elements and prognostic information which can effectively guide the treatment of myocarditis. Issues affecting the diagnostic performance in the setting of acute myocarditis and chronic inflammatory cardiomyopathies will be discussed in this review in the light of recent expert consensus documents on the management of these conditions and on indication to EMB. Recent innovations using electroanatomic mapping (EAM)-guided EMB and fluoroscopic-guided EMB during temporary mechanical circulatory support have improved the utility of the procedure. EMB remains an important diagnostic test whose results need to be interpreted in the context of (1) clinical pre-test probability, (2) timing of sampling, (3) quality of sampling (4) site of sampling, (5) histologic type of myocarditis, and (6) analytic methods that are applied. Herein we will review these caveats as well as perspectives and innovations related to the use of this diagnostic tool.

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  • EMB can be performed safely with a low complication rate of <1% in experienced centers.

    “can be performed safely with a low complication rate of &lt;1% in experienced centers.”

    From Autoimmune Myocarditis, Old Dogs and New Tricks. (2024) · cites this paper as [244]

    The section “Where Should EMB Be Performed: Right, Left, or Both the Ventricles?” (page unavailable) reports cardiac complication rates below 1% for both left- and right-ventricular EMB in two studies. It also reports rates of 1–2% at expert centers in other studies, so the blanket claim of a complication rate below 1% in experienced centers is too strong. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • EMB can aid in categorizing the type of myocarditis based on the type of inflammatory cells on histological findings.

    “EMB is not only useful in confirming the diagnosis of myocarditis but can also aid in categorizing the type of myocarditis based on the type of inflammatory cells on histological findings.”

    From Autoimmune Myocarditis, Old Dogs and New Tricks. (2024) · cites this paper as [244]

  • Fulminant and nonfulminant myocarditis can be differentiated histologically, with fulminant generally associated with extensive lymphocytic infiltrates.

    “The 2 major clinical presentations of myocarditis, fulminant (rapid onset of hemodynamic instability) and nonfulminant, can also be differentiated histologically, with the former generally associated with extensive lymphocytic infiltrates.”

    From Autoimmune Myocarditis, Old Dogs and New Tricks. (2024) · cites this paper as [244]

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Authors
Ammirati, E., Buono, A., Moroni, F., Gigli, L., Power, J. R., Ciabatti, M., Garascia, A., Adler, E. D., & Pieroni, M.
Affiliations
  • Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda (IT)
  • Fondazione Poliambulanza Istituto Ospedaliero (IT)
  • Vita-Salute San Raffaele University (IT)
  • University of California San Diego (US)
  • Ospedale San Donato (IT)
Corresponding author
Ammirati, Enrico
ORCID
Venue
Current Cardiology Reports
Publisher
Springer Science and Business Media LLC
Published
2022-02-24
Volume
24
Issue
5
Pages
597-609
ISSN
  • 1523-3782 (ISSN-L)
  • 1534-3170
DOI
10.1007/s11886-022-01680-x
PMC
PMC8866555
OpenAlex
W4213425565
Cited by
98
References
2
Citations by year
2026: 16 · 2025: 27 · 2024: 25 · 2023: 24 · 2022: 6
FWCI
4.17
Type
journal article
Language
en
Open access
Licence
Locations
  • Current Cardiology Reports (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
Italian Ministry of Health (GR-2019-12368506)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Viral Infections and Immunology Research
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Pericarditis and Cardiac Tamponade
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Fibrosis and Remodeling
Keywords
endomyocardial biopsy, acute myocarditis, myocarditis, mechanical circulatory support, myocarditis diagnosis, heart failure
MeSH terms
Biopsy, Cardiac Catheterization, Heart Failure, Humans, Myocarditis, Myocardium

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