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Review
. 2023 Jan;28(1):123-135.
doi: 10.1007/s10741-022-10247-5. Epub 2022 May 14.

Endomyocardial biopsy in the clinical context: current indications and challenging scenarios

Aldostefano Porcari  1 , Chiara Baggio  1 , Enrico Fabris  1 , Marco Merlo  1 , Rossana Bussani  2 , Andrea Perkan  1 , Gianfranco Sinagra  3
Affiliations
Review

Endomyocardial biopsy in the clinical context: current indications and challenging scenarios

Aldostefano Porcari et al. Heart Fail Rev. 2023 Jan.

Abstract

Endomyocardial biopsy (EMB) is an invasive procedure originally developed for the monitoring of heart transplant rejection. Over the year, this procedure has gained a fundamental complementary role in the diagnostic work-up of several cardiac disorders, including cardiomyopathies, myocarditis, drug-related cardiotoxicity, amyloidosis, other infiltrative and storage disorders, and cardiac tumours. Major advances in EMB equipment and techniques for histological analysis have significantly improved diagnostic accuracy of EMB. In recent years, advanced imaging modalities such as echocardiography with three-dimensional and myocardial strain analysis, cardiac magnetic resonance and bone scintigraphy have transformed the non-invasive approach to diagnosis and prognostic stratification of several cardiac diseases. Therefore, it emerges the need to re-define the current role of EMB for diagnostic work-up and management of cardiovascular diseases. The aim of this review is to summarize current knowledge on EMB in light of the most recent evidences and to discuss current indications, including challenging scenarios encountered in clinical practice.

Keywords: Cardiomyopathies; Cardiovascular imaging; Clinical practice; Diagnosis; Endomyocardial biopsy.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Old generation bioptomes for endomyocardial biopsy
Fig. 2
Fig. 2
Possible histopathological findings in cardiac diseases. A and B Lymphocytic myocarditis with intense inflammatory infiltrates in the myocardium; C and D eosinophilic myocarditis with eosinophilic cells during active degranulation; E and F cardiac sarcoidosis with inflammatory infiltrates and modest myocardial fibrosis and the typical non-caseating sarcoid granuloma; G and H cardiac amyloidosis with vascular and interstitial deposition on Congo red staining. Legend: IHC, Immunohistochemistry
Fig. 3
Fig. 3
Future perspectives on endomyocardial biopsy. Legend: Ab, antibodies; AM, acute myocarditis; CMR, cardiac magnetic resonance; EMB, endomyocardial biopsy; LGE, late gadolinium enhancement; PET, positron emission tomography
See this image and copyright information in PMC

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