[Dilated cardiomyopathy: indication and role of endomyocardial biopsy]

In the last years, endomyocardial biopsy has become a useful diagnostic tool for the investigation and treatment of myocardial diseases. Mainly, its role is irreplaceable for the diagnosis of acute myocarditis. However, its routine use is criticized by some authors for the lack of therapeutic usefulness. Actual techniques enable to perform multiple drawings of tissue samples from both ventricles with low incidence of procedural complications. However, in consideration of the invasivity of the procedure, it is fundamental a correct selection of patients to undergo endomyocardial biopsy. In addition to some particular clinical contexts (after heart transplantation, specific myocardial disease), the more frequent indication to endomyocardial biopsy is suspected myocarditis in patients with "major" symptoms (recent-onset heart failure with relevant left ventricular dysfunction, sustained ventricular arrhythmias). In such cases, the correct analysis of tissue samples represents an important question to answer. The information derived from endomyocardial biopsy is increased by the number of methodologies that we apply. For this reason, it is necessary that traditional histology is followed by immunohistochemical, ultrastructural and molecular biological techniques, which can increase the accuracy of the analysis. About the therapeutic perspectives, endomyocardial biopsy has a role in few clinical cases, according to the persistent perplexity about the therapy of active myocarditis. However, we have to underline that in selected cases endomyocardial biopsy represents a useful method for a correct prognostic and therapeutic evaluation.