Myocarditis and Endomyocardial Biopsy in Unexplained Heart Failure: A Diagnosis in Search of a Disease

Editorials1 October 1988Myocarditis and Endomyocardial Biopsy in Unexplained Heart Failure: A Diagnosis in Search of a DiseaseJ.T. Lie, MDJ.T. Lie, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-109-7-525 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptSakakibara and Konno in 1962 (1) and 1963 (2) first described a safe technique for transvascular, closed chest, right and left ventricular endomyocardial biopsy. Ten years later Caves and associates (3-5) adopted the technique as a useful diagnostic tool for the management of cardiac allograft rejection. In less than a decade, the role of endomyocardial biopsy has been expanded to include the diagnosis of doxorubicin cardiotoxicity, primary and secondary myocardial diseases, and myocarditis (6).Despite endorsements by some investigators (6-8), the diagnostic yield of endomyocardial biopsy for myocarditis in patients with unexplained heart failure appears to be as predictable as...References1. SakakibaraKonno SS. Endomyocardial biopsy. Jpn Heart J. 1962;3:537-43. CrossrefMedlineGoogle Scholar2. KonnoSakakibara SS. Endomyocardial biopsy. Dis Chest. 1963;44:345-50. CrossrefMedlineGoogle Scholar3. CavesStinsonGrahamBillinghamGrehlShumway PEAMTN. Percutaneous transvenous endomyocardial biopsy. JAMA. 1973;225:288-91. CrossrefMedlineGoogle Scholar4. CavesStinsonBillinghamShumway PEMN. Percutaneous transvenous endomyocardial biopsy in human heart recipients: experience with a new technique. Ann Thorac Surg. 1973;16:325-36. CrossrefMedlineGoogle Scholar5. CavesStinsonBillinghamShumway PEMN. Serial transvenous biopsy of the transplant human heart: improved management of acute rejection episodes. Lancet. 1974;1:821-6. CrossrefMedlineGoogle Scholar6. FowlesMason RJ. Endomyocardial biopsy. Ann Intern Med. 1982;97:885-94. LinkGoogle Scholar7. FowlesMason RJ. Role of cardiac biopsy in the diagnosis and management of cardiac disease. Prog Cardiovasc Dis. 1984;27:153-72. CrossrefMedlineGoogle Scholar8. UnverferthBaker DP. Value of endomyocardial biopsy. Am J Med. 1986;80(Suppl 2B):22-32. CrossrefMedlineGoogle Scholar9. MasonBillinghamRicci JMD. Treatment of acute inflammatory myocarditis assisted by endomyocardial biopsy. Am J Cardiol. 1980;45:1037-44. CrossrefMedlineGoogle Scholar10. Noda S. Histopathology of endomyocardial biopsies from patients with idiopathic cardiomyopathy; quantitative evaluation based on multivariate statistical analysis. Jpn Circ J. 1980;44:95-116. CrossrefMedlineGoogle Scholar11. BaandrupFlorioRehahnRichardsonOlsen URMPE. Critical analysis of endomyocardial biopsies from patients suspected of having cardiomyopathy. II: Comparison of histology and clinical/hemodynamic information. Br Heart J. 1981;45:487-93. CrossrefMedlineGoogle Scholar12. DasRathDasSarangi JBSA. Study of endomyocardial biopsies in cardiomyopathy. Indian Heart J. 1981;33:18-26. MedlineGoogle Scholar13. NippoldtEdwardsHolmesBeederHartzlerSmith TWDGGH. Right ventricular endomyocardial biopsy: Clinicopathologic correlates in 100 consecutive patients. Mayo Clin Proc. 1982;57:407-18. MedlineGoogle Scholar14. FenoglioUrsellKelloggDrusinWeiss JPCRM. Diagnosis and classification of myocarditis by endomyocardial biopsy. N Engl J Med. 1983;308:12-8. CrossrefMedlineGoogle Scholar15. DalyRichardsonOlsen KPE. Acute myocarditis: role of histological and virological examination in the diagnosis and assessment of immunosuppressive treatment. Br Heart J. 1984;51:30-5. CrossrefMedlineGoogle Scholar16. ParrilloAretzPalaciosFallonBlock JHIJP. The results of transvenous endomyocardial biopsy can frequently be used to diagnose myocardial diseases in patients with idiopathic heart failure. Endomyocardial biopsies in 100 consecutive patients revealed a substantial incidence of myocarditis. Circulation. 1984;69:93-101. CrossrefMedlineGoogle Scholar17. Zee-ChengTsaiPalmerCoddPenningtonWilliams CCDJDG. High incidence of myocarditis by endomyocardial biopsy in patients with idiopathic congestive cardiomyopathy. J Am Coll Cardiol. 1984;3:63-70. CrossrefMedlineGoogle Scholar18. RoseFraserBeck ARW. Absence of evidence of myocarditis in endomyocardial biopsy specimens from patients with dilated (congestive) cardiomyopathy. S Afr Med J. 1984;66:871-4. MedlineGoogle Scholar19. CasslingLinderSears RJT. Quantitative evaluation of inflammation in biopsy specimens from idiopathically failing or irritable hearts: experience in 80 pediatric and adult patients. Heart J. 1985;110:713-20. CrossrefMedlineGoogle Scholar20. DecPalaciosFallon GIJ. Active myocarditis in the spectrum of acute dilated cardiomyopathies: clinical features, histologic correlates, and clinical outcome. N Engl J Med. 1985;312:885-90. CrossrefMedlineGoogle Scholar21. HosenpudMcAnultyNiles JJN. Lack of objective improvement in ventricular systolic function in patients with myocarditis treated with azathioprine and prednisone. J Am Coll Cardiol. 1985;6:797-801. CrossrefMedlineGoogle Scholar22. ChowDittrichShabetai LHR. Endomyocardial biopsy in patients with unexplained congestive heart failure. Ann Intern Med. 1988;109:535-539. LinkGoogle Scholar23. Uretsky B. Idiopathic "myocarditis"? Letter. J Am Coll Cardiol. 1984;4:1069. CrossrefMedlineGoogle Scholar24. BaandrupOlsen UE. Critical analysis of endomyocardial biopsies from patients suspected of having cardiomyopathy. I. Morphological and morphometric aspects. Br Heart J. 1981;45:475-86. CrossrefMedlineGoogle Scholar25. RoseBeck AW. Dilated (congestive) cardiomyopathy: a syndrome of severe cardiac dysfunction with remarkably few morphological features of myocardial damage. Histopathology. 1985;9:367-79. CrossrefMedlineGoogle Scholar26. YonesakaBecker SA. Dilated cardiomyopathy: diagnostic accuracy of endomyocardial biopsy. Br Heart J. 1987;58:156-61. CrossrefMedlineGoogle Scholar27. Billingham M. Acute myocarditis: a diagnostic dilemma. Br Heart J. 1987;56:6-8. CrossrefGoogle Scholar28. AretzBillinghamEdwards HMW. Myocarditis: a histopathologic definition and classification. Am J Cardiovasc Pathol. 1987;1:3-14. MedlineGoogle Scholar29. ShanesGhaliBillingham JJM. Interobserver variability in the pathologic interpretation of endomyocardial biopsy results. Circulation. 1987;75:401-5. CrossrefMedlineGoogle Scholar30. Report of the WHO/ISFC task force on the definition and classification of cardiomyopathies. Br Heart J. 1980;44:672-3. CrossrefMedlineGoogle Scholar31. HirotaShimizuKakuSaitoKawamura YGKTK. Mechanisms of compensation and decompensation in dilated cardiomyopathy. Am J Cardiol. 1984;54:1033-8. CrossrefMedlineGoogle Scholar32. Olsen E. The pathology of cardiomyopathies: a critical analysis. Am Heart J. 1979;98:385-92. CrossrefMedlineGoogle Scholar33. UnverferthFettersUnverferth DJB. Human myocardial characteristics in congestive heart failure. Circulation. 1983;68:1194-200. CrossrefMedlineGoogle Scholar34. Davies M. The cardiomyopathies: a review of terminology, pathology, and pathogenesis. Histopathology. 1984;8:363-93. CrossrefMedlineGoogle Scholar35. KunkelLappKoberKalgenbach BHGM. Correlations between clinical and morphologic findings and natural history in congestive cardiomyopathy. In: Kaltenbach M, Loogen F, Olsen EG, eds. Cardiomyopathy and Myocardial Biopsy. Berlin: Springer Verlag; 1978:271-83. Google Scholar36. ShireyProudfitHawk EWW. Primary myocardial disease. Correlation with clinical findings, angiographic and biopsy diagnosis: Follow-up of 139 patients. Am Heart J. 1980;99:198-207. CrossrefMedlineGoogle Scholar37. BreithardtKuhnKnieriem GHH. Prognostic significance of endomyocardial biopsy in patients with congestive heart failure. In: Kaltenbach M, Loogen F, Olsen EGJ, eds. Cardiomyopathy and Myocardial Biopsy. Berlin: Springer Verlag, 1978:258-70. CrossrefGoogle Scholar38. SekiguchiHiroeMorimoto MMS. On the standardization of histopathological diagnosis and semiquantitative assessment of the endocardium obtained by endomyocardial biopsy. Bull Heart Inst Jpn. 1979-1980; 55-85. Google Scholar39. Goodwin J. The frontiers of cardiomyopathy. Br Heart J. 1982;48:1-18. CrossrefMedlineGoogle Scholar40. KawaiMatsumoriFujiwara CAH. Myocarditis and dilated cardiomyopathy. Annu Rev Med. 1987;38:221-39. CrossrefMedlineGoogle Scholar41. BillinghamTazelaar MH. The morphological progression of viral myocarditis. Postgrad Med J. 1986;62:581-4. CrossrefMedlineGoogle Scholar42. Woodruff J. Viral myocarditis: a review. Am J Pathol. 1980;101:425-84. MedlineGoogle Scholar43. CambridgeMacArthurWatersonGoodwinOakley GCAJC. Antibodies to Coxsackie B viruses in congestive cardiomyopathy. Br Heart J. 1979;41:692-6. CrossrefMedlineGoogle Scholar44. Olsen E. Myocarditis©a case of mistaken identity? Br Heart J. 1983;50:303-11. CrossrefMedlineGoogle Scholar45. JacobsMatsudaDeodharShirey BYSE. Cell-mediated cytotoxicity to cardiac cells of lymphocytes from patients with primary myocardial disease. Am J Clin Pathol. 1979;72:1-4. CrossrefMedlineGoogle Scholar46. FowlesBieberStinson RCE. Defective in vitro suppressor cell function in idiopathic congestive cardiomyopathy. Circulation. 1979;59:483-91. CrossrefMedlineGoogle Scholar47. HammondMenloveAnderson ERJ. Predictive value of immunofluorescence and electron microscopic evaluation of endomyocardial biopsies in the diagnosis and prognosis of myocarditis and idiopathic dilated cardiomyopathy. Am Heart J. 1987;114:1055-65. CrossrefMedlineGoogle Scholar48. BaandrupFlorioOlsen URE. Do endomyocardial biopsies represent the morphology of the rest of the myocardium? A quantitative light microscopic study of single v. multiple biopsies with the King's bioptome. Europ Heart J. 1982;3:171-8. CrossrefMedlineGoogle Scholar49. FerransRoberts VW. Myocardial biopsy: a useful diagnostic procedure or only a research tool? Am J Cardiol. 1978;41:965-7. CrossrefMedlineGoogle Scholar50. Saphir O. Myocarditis: a general review with an analysis of two-hundred and forty cases. Arch Pathol. 1942;33:88-137. Google Scholar51. KlineKlineSaphir ITO. Myocarditis in senescence. Am Heart J. 1963;65:446-57. CrossrefMedlineGoogle Scholar52. Hosenpud J. Chronic idiopathic myocarditis: controversies in causes and therapy. Cardiovasc Rev Rep. 1988;9(5):32-7. Google Scholar53. EdwardsHolmesReeder WDG. Diagnosis of active lymphocytic myocarditis by endomyocardial biopsy: quantitative criteria for light microscopy. Mayo Clin Proc. 1982;57:419-25. MedlineGoogle Scholar54. TazelaarBillingham HM. Leukocytic infiltrates in idiopathic dilated cardiomyopathy: a source of confusion with acute myocarditis. Am J Surg Pathol. 1986;10:405-12. CrossrefMedlineGoogle Scholar55. TazelaarBillingham HM. Myocardial lymphocytes: fact, fancy, or myocarditis? Am J Cardiovasc Pathol. 1987;1:47-50. MedlineGoogle Scholar56. KereiakesParmley DW. Myocarditis and cardiomyopathy. Am Heart J. 1984;108:1318-26. CrossrefMedlineGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Mayo Clinic and Mayo Medical School Rochester, Minnesota PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited ByThe Role of Native T1 Mapping in the Diagnosis of Myocarditis in a Real-World SettingThe value of endomyocardial biopsy in diagnosis and guiding therapyAdvances in Quantitative Tissue Characterization in MyocarditisMyocardial T1 maps reflect histological findings in acute and chronic stages of myocarditis in a rat modelRole of Endomyocardial Biopsy for Children Presenting With Acute Systolic Heart FailureCorrelation of left ventricular wall thickness, heart mass, serological parameters and late gadolinium enhancement in cardiovascular magnetic resonance imaging of myocardial inflammation in an experimental animal model of autoimmune myocarditisAccuracy of cardiovascular magnetic resonance in myocarditis: comparison of MR and histological findings in an animal modelArrhythmias and Elevated Troponin I in a Dog With Steroid-Responsive Meningitis-ArteritisAcute myocarditis in a rat model: late gadolinium enhancement with histopathological correlation2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in AdultsAcute myopericarditis masquerading as acute myocardial infarctionEarly diagnosis of focal myocarditis by cardiac magnetic resonanceSurvival in biopsy-proven myocarditis: A long-term retrospective analysis of the histopathologic, clinical, and hemodynamic predictorsFocal myocardial fibrosis and edema in acute myocarditis demonstrated by multislice computed tomographyACC/AHA 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the AdultA rare case of concomitant viral myocarditis and pericarditis in a 44-year-old patientEndomyocardial biopsy plays a role in diagnosing patients with unexplained cardiomyopathyEndomyocardial biopsy: a procedure in search of an indicationA formidable challengeLong-term outcome of acute myocarditis is independent of cardiac enzyme releaseWhich Congestive Heart Failure Patient Needs to Be Studied in Haemodynamic Laboratory and When?Association of Viral Genome with Graft Loss in Children after Cardiac TransplantationMyocarditisGiant cell myocarditis: Most fatal of autoimmune diseasesDilatative Kardiomyopathie (DCM) Morphologie und Ätiologie. Myokarditis und DCMHerzMyocarditis: a reviewAdenovirus and the MyocardiumViral MyocarditisFavorable effects of immunosuppressive therapy in children with dilated cardiomyopathy and active myocarditisAnalysis of formalin-fixed and frozen myocardial autopsy samples for viral genome in childhood myocarditis and dilated cardiomyopathy with endocardial fibroelastosis using polymerase chain reaction (PCR)Scintigraphic detection of inflammatory heart diseaseClinical and prognostic significance of detection of enteroviral RNA in the myocardium of patients with myocarditis or dilated cardiomyopathy.Immunological Aspects of Cardiovascular DiseasesINFLAMMATORY HEART DISEASE: Pathogenesis, Clinical Manifestations, and Treatment of MyocarditisDilated cardiomyopathy and myocarditis in Kenya: an endomyocardial biopsy studyVentricular fibrillation in patients without significant structural heart disease: A multicenter experience with implantable cardioverter-defibrillator therapyEpidemiology of Idiopathic Dilated CardiomyopathyAntimyosin scintigraphy in cardiovascular diseasesEndomyocardial biopsies in cardiomyopathies of childhoodMyocyte necrosis-avid imaging with radiolabeled antimyosin antibody: experimental and clinical acute myocardial infarction, myocarditis and heart transplant rejectionClinicopathoiogic description of myocarditisFamilial dilated cardiomyopathy: a transverse and longitudinal clinical and echocardiographic studyEndomyocardial biopsy in dilated cardiomyopathy and myocarditis: which role?The incidence of myocarditis in endomyocardial biopsy samples from patients with congestive heart failureThe Endomyocardial Biopsy RevisitedCardiac biopsy in myocarditisIdiopathic ventricular fibrillationMyocarditis: Unresolved issues in diagnosis and treatment“Borderline” myocarditis: An indication for repeat endomyocardial biopsyA Prospective, Randomized, Controlled Trial of Prednisone for Dilated CardiomyopathyInsensitivity of right ventricular endomyocardial biopsy in the diagnosis of myocarditisEvaluation of Postmortem Endomyocardial Biopsy Specimens From 38 Patients With Lymphocytic Myocarditis: Implications for Role of Sampling ErrorClinical merit of endomyocardial biopsy.The Histologic Diagnosis of MyocarditisRicky D. Latham, MD, Renu Virmani, MDMyocarditis and Endomyocardial BiopsyMargaret E. Billingham, MBBSNew Insights and Updates for Established Entities 1 October 1988Volume 109, Issue 7Page: 525-528KeywordsBiopsyHeart diseasesHeart failureMyocarditisThorax Issue Published: 1 October 1988 PDF DownloadLoading ...