[Endomyocardial biopsy: experience with 156 patients].

Transcatheter endomyocardial biopsy (EMB) is a well known technique but its clinical value is still controversial. Our experience in the first 156 patients studied, in whom 182 EMB were performed, is reported and particular attention is given to the clinical value of the biopsy. Complications were observed in 7 patients and left ventricular EMB appeared to be more complicated (2/23) than right ventricular EMB (5/159). The clinical value of EMB was well documented (63.5%) in patients with congestive heart failure and a dilated heart (group 1) in whom a fairly high presence of myocarditis (17.5%), in different stages, was observed (13/74 patients). In patients with congestive failure and a restrictive/constrictive physiology (group 2), with angina and normal coronary arteries (group 3) and with acute advanced atrio-ventricular block and young age (group 5) the clinical value of EMB was good (85.7%, 58.3% and 60.6% respectively). The clinical value of EMB was on the contrary poor in patients with idiopathic ventricular arrhythmias (group 4) and in an heterogeneous group of patients (group 7), where EMB was mainly performed to exclude myocarditis. EMB had no clinical value in patients with aortic or mitral incompetence (group 6) studied according to a research protocol. EMB is a safe procedure which provides useful clinical informations in more than 50% of patients studied. The fairly high incidence of myocarditis (25 out of 156 patients studied) and the protean clinical presentations of the disease are stressed.