Laser J A, Fowles R E, Mason J W
Cardiovasc Clin. 1985;15(1):141-63.
Endomyocardial biopsy is an accepted, useful invasive tool for the analysis of human endomyocardium at the cellular and subcellular levels. It is applicable in the evaluation of specific diseases including cardiac allograft rejection, myocarditis, anthracycline cardiotoxicity, and infiltrative cardiomyopathies. The procedure can be performed in a cardiac catheterization room on an outpatient basis. The technique is quite safe when performed by trained cardiologists. Left ventricular biopsies are also safe but require systemic heparinization to prevent thromboembolization. The clinical indications for performing an endomyocardial biopsy include routine followup and suspected rejection of cardiac allograft, suspected myocarditis, monitoring or diagnosis of suspected anthracycline cardiotoxicity, and suspected secondary cardiomyopathies. Left ventricular endomyocardial biopsy is indicated for diseases that predominantly involve the left side of the heart, including left heart irradiation, cardiac fibroelastosis in infants, endomyocardial fibrosis, and scleroderma heart disease, and when right ventricular biopsy is unsuccessful. Endomyocardial biopsy is increasingly being used for research in the areas of tissue biochemistry, primary and valvular cardiomyopathies, immunology, beta receptor enzymology, drug interactions, and myocardial fibrosis. Endomyocardial biopsy has not been shown to be clinically useful in the evaluation of primary, dilated, hypertrophic, or alcoholic cardiomyopathies. These disease processes all lack pathognomomic microscopic abnormalities, and subclassification has neither been successful nor therapeutically useful. In addition, this technique is limited in diagnosing any cardiac abnormality that is not diffuse, inasmuch as only a few samples of the endomyocardial layer are obtained for evaluation. Therefore, a negative biopsy result is not 100 percent specific in excluding certain diseases. A further limitation of this technique is the need for an experienced cardiac pathologist who is well versed in interpretation of biopsy specimens. Finally, there should be a sufficiently large case load to train and to maintain skilled practitioners so that the procedure can be performed with little risk. The role of endomyocardial biopsy will continue to expand as research continues to find more uses for the technique and as more clinicians become skilled in its use.
心内膜心肌活检是一种公认的、有用的侵入性工具，可在细胞和亚细胞水平分析人类心内膜。它适用于评估特定疾病，包括心脏移植排斥反应、心肌炎、蒽环类药物心脏毒性和浸润性心肌病。该操作可在心脏导管室作为门诊手术进行。由训练有素的心脏病专家进行时，该技术相当安全。左心室活检也很安全，但需要全身肝素化以防止血栓栓塞。进行心内膜心肌活检的临床指征包括心脏移植的常规随访和疑似排斥反应、疑似心肌炎、监测或诊断疑似蒽环类药物心脏毒性以及疑似继发性心肌病。左心室心内膜心肌活检适用于主要累及心脏左侧的疾病，包括左心放疗、婴儿心脏纤维弹性组织增生症、心内膜纤维化和硬皮病性心脏病，以及右心室活检不成功时。心内膜心肌活检越来越多地用于组织生物化学、原发性和瓣膜性心肌病、免疫学、β受体酶学、药物相互作用和心肌纤维化等领域的研究。心内膜心肌活检在评估原发性、扩张型、肥厚型或酒精性心肌病方面尚未显示出临床实用性。这些疾病过程都缺乏特征性的微观异常，且亚分类既未成功也无治疗价值。此外，该技术在诊断任何非弥漫性心脏异常方面存在局限性，因为仅获取少数心内膜层样本进行评估。因此，活检结果为阴性并不能100%排除某些疾病。该技术的另一个局限性是需要一位经验丰富、精通活检标本解读的心脏病理学家。最后，应有足够多的病例量来培训和维持熟练的从业者，以便能在低风险下进行该操作。随着研究不断发现该技术的更多用途以及越来越多的临床医生熟练掌握其应用，心内膜心肌活检将继续发挥更大的作用。
