Heart Failure Society of America and Heart Failure Association of the European Society of Cardiology. The Role of Endomyocardial Biopsy in the Management of Cardiovascular Disease. A Scientific Statement From the American Heart Association, the American College of Cardiology and the European Society of Cardiology

Mayo Clinic.
Circulation (Impact Factor: 14.43). 12/2007; 116(19):2216-33. DOI: 10.1161/CIRCULATIONAHA.107.186093
Source: PubMed

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    • "Thus, EMB may cause pericardial tamponade, severe arrhythmias or structural damages of the tricuspid valve [1] . Since sensitivity of EMB is low, clinicians are forced to increase the amount of samples (> 6, according to the AHA/ACCF/ESC scientific statement [1] ) while focal pathologies like fibrosis in different forms of myocarditis may remain undetected. In the clinical routine, fluoroscopy is used to guide the EMB procedure, offering a high frame rate (≤ 30 fps) and high spatial resolution (2-3 line pairs/mm). "
    [Show abstract] [Hide abstract] ABSTRACT: To investigate if magnetic resonance (MR)-guided biopsy can improve the performance and safety of such procedures. A novel MR-compatible bioptome was evaluated in a series of in-vitro experiments in a 1.5T magnetic resonance imaging (MRI) system. The bioptome was inserted into explanted porcine and bovine hearts under real-time MR-guidance employing a steady state free precession sequence. The artifact produced by the metal element at the tip and the signal voids caused by the bioptome were visually tracked for navigation and allowed its constant and precise localization. Cardiac structural elements and the target regions for the biopsy were clearly visible. Our method allowed a significantly better spatial visualization of the bioptoms tip compared to conventional X-ray guidance. The specific device design of the bioptome avoided inducible currents and therefore subsequent heating. The novel MR-compatible bioptome provided a superior cardiovascular magnetic resonance (imaging) soft-tissue visualization for MR-guided myocardial biopsies. Not at least the use of MRI guidance for endomyocardial biopsies completely avoided radiation exposure for both patients and interventionalists. MRI-guided endomyocardial biopsies provide a better than conventional X-ray guided navigation and could therefore improve the specificity and reproducibility of cardiac biopsies in future studies.
    Full-text · Article · Aug 2015 · World Journal of Cardiology (WJC)
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    • "There is still controversy in many medical centers about the role of EMB in the diagnosis and treatment of myocarditis, mostly because the procedural risks do not always outweigh the incremental value of EMB, as the majority of myocarditis patients have a good prognosis. The highest Healed inflammation with or without irreversible damage to the heart Histology Lymphocytic Giant cell Granulomatous Eosinophilic Neutrophilic Etiology Infectious: viral, bacterial, spirochaetal, fungal, protozoal, parasitic, and rickettsial Autoimmune: allergens, alloantigens, and autoantigens Toxic agents: drugs, alcohol, radiation, and chemicals yield of EMB is reached in myocarditis patients who present with acute heart failure [21]. In these patients, EMB can exclude more aggressive disorders like giant cell myocarditis or necrotizing granulomatous myocarditis and can guide treatment. "
    [Show abstract] [Hide abstract] ABSTRACT: Myocarditis, i.e. inflammation of the myocardium, is one of the leading causes of sudden cardiac death (SCD) and dilated cardiomyopathy (DCM) in young adults, and is an important cause of symptoms such as chest pain, dyspnea and palpitations. The pathophysiological process of disease progression leading to DCM involves an ongoing inflammation as a result of a viral-induced auto-immune response or a persisting viral infection. It is therefore crucial to detect the disease early in its course and prevent persisting inflammation that may lead to DCM and end-stage heart failure. Because of the highly variable clinical presentation, ranging from mild symptoms to severe heart failure, and the limited available diagnostic tools, the evaluation of patients with suspected myocarditis represents an important clinical dilemma in cardiology. New approaches for the diagnosis of myocarditis are needed in order to improve recognition, to help unravel its pathophysiology, and to develop new therapeutic strategies to treat the disease. In this review, we give a comprehensive overview of the current diagnostic strategies for patients with suspected myocarditis, and demonstrate several new techniques that may help to improve the diagnostic work-up. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.
    Full-text · Article · May 2015 · International journal of cardiology
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    • "It should be emphasized that the biopsy procedure was performed at patients with chronic and clinically stable heart failure treated optimally for at least 6 months without complete recovery. It is relatively late according to current clinical practice guidelines [26] and partly explains the low percentage of active myocarditis. The increased concentrations of NPT are found in dilated cardiomyopathy group with strong immune activation—HLA expression in endomyocardium in comparison to controls, but the difference with the group of weak immune activation was not significant. "
    [Show abstract] [Hide abstract] ABSTRACT: Background: The aim of the study was to assess the relationships among serum neopterin (NPT), β2-microglobulin (β2-M) levels, clinical status, and endomyocardial biopsy results of dilated cardiomyopathy patients (DCM). Methods: Serum NPT and β-2 M were determined in 172 nonischaemic DCM patients who underwent right ventricular endomyocardial biopsy and 30 healthy subjects (ELISA test). The cryostat biopsy specimens were assessed using histology, immunohistology, and immunochemistry methods (HLA ABC, HLA DR expression, CD3 + lymphocytes, and macrophages counts). Results: The strong increase of HLA ABC or HLA DR expression was detected in 27.2% patients-group A-being low in 72.8% patients-group B. Neopterin level was increased in patients in group A compared to healthy controls 8.11 (4.50-12.57) versus 4.99 (2.66-8.28) nmol/L (P < 0.05). β-2 microglobulin level was higher in DCM groups A (2.60 (1.71-3.58)) and B (2.52 (1.51-3.72)) than in the control group 1.75 (1.28-1.96) mg/L, P < 0.001. Neopterin correlated positively with the number of macrophages in biopsy specimens (P < 0.05) acute phase proteins: C-reactive proteins (P < 0.05); fibrinogen (P < 0.01); and NYHA functional class (P < 0.05) and negatively with left ventricular ejection fraction (P < 0.05). Conclusions: Neopterin but not β-2 microglobulin concentration reflected immune response in biopsy specimens. Neopterin correlated with acute phase proteins and stage of heart failure and may indicate a general immune and inflammatory activation in heart failure.
    Full-text · Article · Aug 2014 · Mediators of Inflammation
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