De Gasperis" Cardio Center and Transplant Center, Niguarda Hospital, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore, 3, 20162, Milan, Italy.
Interventional Cardiology Unit, Cardiovascular Department, Fondazione Poliambulanza, Brescia, Italy.
Curr Cardiol Rep. 2022 May;24(5):597-609. doi: 10.1007/s11886-022-01680-x. Epub 2022 Feb 24.
Histologic evidence of myocardial inflammatory infiltrate not secondary to an ischemic injury is required by current diagnostic criteria to reach a definite diagnosis of myocarditis. Endomyocardial biopsy (EMB) is therefore often indicated for the diagnosis of myocarditis, although it may lack sufficient sensitivity considering the limited possibility of myocardial sampling. Improving the diagnostic yield and utility of EMB is of high priority in the fields of heart failure cardiology and myocarditis in particular. The aim of the present review is to highlight indications, strengths, and shortcomings of current EMB techniques, and discuss innovations currently being tested in ongoing clinical studies, especially in the setting of acute myocarditis and chronic inflammatory cardiomyopathy.
EMB provides unique diagnostic elements and prognostic information which can effectively guide the treatment of myocarditis. Issues affecting the diagnostic performance in the setting of acute myocarditis and chronic inflammatory cardiomyopathies will be discussed in this review in the light of recent expert consensus documents on the management of these conditions and on indication to EMB. Recent innovations using electroanatomic mapping (EAM)-guided EMB and fluoroscopic-guided EMB during temporary mechanical circulatory support have improved the utility of the procedure. EMB remains an important diagnostic test whose results need to be interpreted in the context of (1) clinical pre-test probability, (2) timing of sampling, (3) quality of sampling (4) site of sampling, (5) histologic type of myocarditis, and (6) analytic methods that are applied. Herein we will review these caveats as well as perspectives and innovations related to the use of this diagnostic tool.
目前的诊断标准要求心肌炎症浸润的组织学证据不是继发于缺血性损伤，才能明确诊断心肌炎。因此，尽管考虑到心肌取样的可能性有限，心内膜心肌活检（EMB）通常用于心肌炎的诊断，但它可能缺乏足够的敏感性。提高 EMB 的诊断效果和实用性是心力衰竭心脏病学和心肌炎领域的当务之急。本综述的目的是强调当前 EMB 技术的适应证、优势和局限性，并讨论当前正在进行的临床研究中正在测试的创新，特别是在急性心肌炎和慢性炎症性心肌病的背景下。
EMB 提供了独特的诊断元素和预后信息，可以有效地指导心肌炎的治疗。本文将根据最近关于这些疾病管理的专家共识文件以及 EMB 的适应证，讨论影响急性心肌炎和慢性炎症性心肌病背景下诊断性能的问题。最近使用电解剖图（EAM）引导的 EMB 和在临时机械循环支持期间进行的荧光引导 EMB 的创新提高了该程序的实用性。EMB 仍然是一种重要的诊断测试，其结果需要结合（1）临床预测试概率、（2）采样时间、（3）采样质量、（4）采样部位、（5）心肌炎的组织学类型和（6）应用的分析方法进行解释。在此，我们将回顾这些注意事项以及与该诊断工具使用相关的观点和创新。
