Current status of myocarditis and endomyocardial biopsy in Brazil

The results presented here show the inadequate attention that has been paid to myocarditis as a clinical entity and to employing endomyocardial biopsy examination as a valuable tool for diagnostic and research purposes. The results must be interpreted with caution, as otherwise false conclusions may be drawn as far as the epidemiological profile of cardiovascular diseases in Brazil is concerned. The data are likely to be influenced by the striking regional differences in development which are reflected in the scientific output. The high incidence of positive serology in patients in endemic areas of Trypanosoma cruzi infection is a further complication. It is possible that Chagas' disease may be overestimated clinically, decreasing therefore the interest in clarifying diseases with comparable clinical features. Myocarditis (excluding a protozoal etiology) and dilated (congestive) cardiomyopathy may serve as examples. Considering these various points, together with the complex and multi-disciplinary requirements of obtaining and interpreting catheter biopsies of the heart explains the limited clinical application of this technique in Brazil.