Current status of endomyocardial biopsy
Aaron M From1, Joseph J Maleszewski, Charanjit S Rihal
1Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA..
Mayo Clinic Proceedings
|October 29, 2011
Summary
Endomyocardial biopsy (EMB) is crucial for monitoring heart transplant rejection. However, its use for diagnosing other heart conditions in non-transplant patients is debated, as noninvasive methods are often sufficient.
Area of Science:
- Cardiology
- Pathology
- Transplant Medicine
Background:
- Endomyocardial biopsy (EMB) is a standard procedure for heart transplant recipients to monitor for rejection.
- It is also used to diagnose unexplained ventricular dysfunction.
Purpose of the Study:
- To evaluate the role and controversies surrounding endomyocardial biopsy in diagnosing myocardial diseases, particularly in non-transplant patients.
- To determine when EMB provides essential diagnostic information beyond noninvasive testing.
Main Methods:
- Review of current practices and literature regarding endomyocardial biopsy.
- Comparison of diagnostic yield of EMB versus noninvasive investigations for myocardial diseases.
Main Results:
- EMB has a low acute complication rate (<1%) when performed using modern flexible bioptomes.
- Noninvasive methods like echocardiography, MRI, and lab tests are often sufficient for diagnosing myocardial diseases in non-transplant recipients.
- The utility of EMB is patient-specific, depending on the need for pathological diagnosis to guide prognosis and treatment.
Conclusions:
- Endomyocardial biopsy remains essential for cardiac allograft rejection surveillance.
- Its application in diagnosing non-transplant myocardial diseases is controversial and should be considered on a case-by-case basis.
- The decision to perform EMB should weigh the potential prognostic and treatment benefits against information obtainable through noninvasive means.
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