Role of Endomyocardial Biopsy in Diagnostics of Myocarditis
Liga Vidusa1, Oskars Kalejs2,3, Aija Maca-Kaleja2,3
1Department of Pathology, Riga Stradins University, 16 Dzirciema Street, LV-1007 Riga, Latvia.
Insights
Endomyocardial biopsy use in myocarditis diagnosis is debated, with non-invasive methods preferred for most cases. Biopsy remains crucial for specific subtypes and differentiating causes of myocardial inflammation.
Area of Science:
- Cardiology
- Pathology
- Infectious Diseases
Background:
- The role of endomyocardial biopsy (EMB) in diagnosing myocarditis has been questioned.
- Myocarditis incidence increased during the COVID-19 pandemic, prompting diagnostic re-evaluation.
- Evidence-based literature from the last five years highlights ongoing debate.
Purpose of the Study:
- To evaluate the current role of EMB in myocarditis diagnostics and management.
- To summarize recent information on EMB utility, safety, and necessity.
- To assess diagnostic accuracy and terminology in myocardial inflammation.
Main Methods:
- Systematic review of evidence-based literature published in the last five years.
- Analysis of studies focusing on endomyocardial biopsy in myocarditis.
- Evaluation of diagnostic approaches and clinical outcomes.
Main Results:
- Significant uncertainty persists regarding the use, informativeness, and safety of EMB.
- Non-invasive diagnostic approaches are increasingly applied for most myocarditis cases.
- Fulminant cases and treatment-refractory myocarditis remain key indications for EMB.
- EMB is critical for treatment adjustment in specific histological subtypes and differential diagnosis.
- High potential for misdiagnosis necessitates reviewing myocardial inflammation terminology.
Conclusions:
- EMB, when performed correctly with adjunct methods, is vital for specific myocarditis subtypes.
- EMB aids in differentiating immune-mediated myocarditis from secondary infections.
- Non-invasive methods are gaining prominence, but EMB retains a critical role in select scenarios.
- Standardization of terminology for myocardial inflammation is needed to improve diagnostic accuracy.
Abstract:
Endomyocardial biopsy as the cornerstone of diagnostics has been re-evaluated throughout the years, leaving unanswered questions on the precedence of it. The reported incidence of myocarditis has increased during the pandemic of coronavirus disease 2019 (COVID-19), reinforcing discussions on appropriate diagnostics of myocarditis. By analysis of evidence-based literature published within the last demi-decade, we aimed to summarize the most recent information in order to evaluate the current role of endomyocardial biopsy in diagnostics and management of myocarditis. For the most part, research published over the last five years showed ongoing uncertainty regarding the use, informativeness, safety and necessity of performing a biopsy. Special circumstances, such as fulminant clinical course or failure to respond to empirical treatment, were reconfirmed as justified indications, with a growing applicability of non-invasive diagnostic approaches for most other cases. We concluded that endomyocardial biopsy, if performed properly and with adjunct diagnostic methods, holds a critical role for treatment correction in specific histological subtypes of myocarditis and for differential diagnosis between immune-mediated myocarditis and secondary infections due to immunosuppressive treatment. A high level of possible misdiagnosing was detected, indicating the need to review terminology used to describe findings of myocardial inflammation that did not meet Dallas criteria.
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