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Endomyocardial biopsy--its evaluation in cardiac disorders
V Malhotra1, M Tatke, R Gondal
1Department of Pathology and Cardiology, G. B. Pant Hospital, New Delhi.
Insights
Endomyocardial biopsies (EMBs) in dilated cardiomyopathy (DCM) patients rarely show myocarditis. This study found no evidence of myocarditis in EMBs from DCM cases, challenging clinical diagnoses.
Area of Science:
- Cardiology
- Pathology
- Histology
Background:
- Endomyocardial biopsy (EMB) is crucial for diagnosing cardiac conditions.
- Distinguishing dilated cardiomyopathy (DCM) from myocarditis is clinically important.
- Previous studies suggest potential overlap in histological findings.
Purpose of the Study:
- To evaluate the diagnostic yield of EMB in various cardiac disorders.
- Specifically, to determine the presence of myocarditis in clinically diagnosed DCM patients.
- To correlate EMB findings with clinical diagnoses of restrictive heart disease and Duchenne muscular dystrophy.
Main Methods:
- Analysis of 47 endomyocardial biopsies (EMBs) from patients with diverse cardiac conditions.
- Histopathological examination of myocardial tissue.
- Correlation of biopsy findings with clinical diagnoses including dilated cardiomyopathy (DCM), myocarditis, restrictive heart disease, and Duchenne muscular dystrophy.
Main Results:
- EMB showed normal histology in 6/26 DCM cases and DCM consistent findings in 20/26 DCM cases.
- None of the EMBs from DCM patients revealed evidence of myocarditis.
- Myocarditis diagnosis was confirmed by EMB in only 3/9 clinically diagnosed myocarditis cases.
- Restrictive heart disease cases showed varied findings: normal (2), infarction (1), endomyocardial fibrosis (1), and amyloidosis (2).
- EMB in Duchenne muscular dystrophy cases revealed nonspecific histological changes.
Conclusions:
- Endomyocardial biopsies in this series did not support the presence of myocarditis in patients diagnosed with dilated cardiomyopathy (DCM).
- EMB confirmation rates for myocarditis and specific findings in other cardiac conditions were variable.
- The study highlights discrepancies between clinical diagnosis and EMB findings, particularly for DCM and myocarditis.
Abstract:
Endomyocardial biopsies (EMBs) of 47 patients with various cardiac disorders were analysed. Clinically 26 patients were diagnosed as having dilated cardiomyopathy (DCM), 9 myocarditis, six restrictive heart disease and six as Duchenne muscular dystrophy. EMB showed normal histological picture in six cases of DCM and findings consistent with DCM in rest of the twenty cases. None of these biopsies showed evidence of myocarditis. Diagnosis of myocarditis could be confirmed on EMB only in three out of nine clinically diagnosed cases. Cases with restrictive heart disease showed normal biopsy in two, infarction in one, findings consistent with endomyocardial fibrosis in one and amyloidosis in two cases. EMB on six cases of Duchenne muscular dystrophy showed nonspecific histological changes. To conclude, in this series, cases of DCM did not show evidence of underlying myocarditis in endomyocardial biopsies.