Endomyocardial biopsy
Summary
In the past, the most frequent indication for performing EMB was to monitor the presence or absence of cardiac allograft rejection in patients who underwent cardiac transplantation. Today, the spectrum of possible EMB indications has broadened and comprises work-up of non-ischaemic cardiomyopathies such as viral myocarditis, inflammatory dilated cardiomyopathy (iDCM), infiltrative cardiomyopathies, hypertrophic cardiomyopathy (HCM) or restrictive cardiomyopathy, and rare myocardial diseases with potential life-saving therapeutic options such as giant cell myocarditis, cardiac amyloidosis or cardiac sarcoidosis. In principal, the potential benefits of the EMB information (the guidance of therapeutic decisions and prognosis) have to be weighed-up against pre-existing information based on non-invasive methods, and the risk of complications in each individual when performing invasive EMB.
Since numerous recent studies have shown that firstly, the information given by EMB work-up is of diagnostic, therapeutic and prognostic value and secondly, the complication risk of EMB is rather low when performed by experienced physicians, EMB is still the gold-standard for the diagnosis of most cardiomyopathies. However, a thorough knowledge regarding the correct indication for performing EMB, the practical details of the EMB procedure, important safety issues and the essential post-procedural EMB analysis tools are a prerequisite for a clinically meaningful and practically...
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