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Myocarditis and endomyocardial biopsy.

W D Edwards

    Cardiology Clinics
    |November 1, 1984
    PubMed
    Summary
    This summary is machine-generated.

    Diagnosing myocarditis (inflammation of the heart muscle) is challenging, with both clinical and biopsy methods prone to errors. Quantitative analysis of inflammatory cells in heart biopsy tissue offers the most reliable diagnostic criterion.

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    Area of Science:

    • Cardiology
    • Pathology
    • Immunology

    Background:

    • Clinical and biopsy diagnoses of myocarditis (heart muscle inflammation) often lack correlation and are susceptible to misinterpretation.
    • Unexplained heart failure with sudden onset or rapid progression is frequently, but often incorrectly, presumed to be myocarditis.
    • False-negative clinical diagnoses can occur when myocarditis symptoms are atypical or absent.

    Purpose of the Study:

    • To critically evaluate the diagnostic accuracy of clinical and biopsy assessments for myocarditis.
    • To identify common sources of error in both clinical and histopathological diagnoses of myocarditis.
    • To establish reliable histopathological criteria for diagnosing myocarditis in myocardial biopsy tissue.

    Main Methods:

    • Review of common errors leading to false-positive and false-negative clinical diagnoses of myocarditis.

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  • Analysis of histopathological findings in myocardial biopsies, focusing on inflammatory infiltrates and myocardial injury.
  • Identification of potential pitfalls in biopsy interpretation, including misinterpreting interstitial cells and sampling errors.

    • Main Results:

    • Clinical diagnosis of myocarditis is often presumptive and lacks definitive proof.
    • False-positive biopsy diagnoses arise from misinterpreting normal interstitial lymphocytes or non-inflammatory cells.
    • Sampling errors are a significant cause of false-negative biopsy diagnoses for myocarditis.

    Conclusions:

    • Quantitative evidence of interstitial leukocytic infiltrate is the most reliable histopathologic criterion for diagnosing myocarditis.
    • Myocarditis biopsy diagnoses should be categorized as present, borderline, or absent, and subsequent biopsies evaluated temporally (ongoing, resolving, resolved).
    • Accurate and unbiased histopathological evaluation is crucial, as myocarditis diagnoses often lead to immunosuppressive therapy with potential risks.