The usefulness of endomyocardial biopsy in heart failure syndrome

Abstract

Objective: the aim of this paper is to offer clear recommendations for the clinical utilization of endomyocardial biopsy within the context of the heart failure syndrome, laying emphasis on evidence-based medicine through a systematic review of the literature.

Methods: original research papers and meta-analyses were studied. Papers were found through Medline, Google Scholarship and Cochrane, by using the terms "endomyocardial", "biopsy", "myocarditis" and "cardiomyopathy".

Results: thirteen very heterogeneous articles were selected. Due to their heterogeneous nature, statistical measurements were not performed. In this paper the authors present an academic discussion of some of these articles.

Conclusions: histopathologic study of cardiac tissue has become a useful tool in the workup of patients with congestive heart failure and dilated cardiomyopathy. The incidence of complications varies from 1 to 6%, with a mortality rate of 0.4% according to the clinical series studied. Mortality is decisively influenced by the operator"(TM)s experience. In order to optimize its diagnostic possibilities, biopsy should be accompanied by complete anatomopathological analysis, including conventional, special and immunohistochemical stains, as well as new techniques such as polymerase chain reaction (PCR), and reverse transcriptase-PCR analysis for most cardiotropic viruses and the expression of HLA antigens. Endomyocardial biopsy is a useful tool in the follow-up of the heart transplant patient, in order to diagnose acute rejection. It is also useful in the follow-up of patients with drug toxicity issues, and in order to diagnose patients with systemic or infiltrative diseases, new onset congestive heart failure and other conditions.