Diagnostic Methods Myocardial Disease

Transvenous endomyocardial biopsy is an accepted method to evaluate cardiac transplant rejection, but the clinical diagnostic value of the technique for other forms of cardiac disease has not been established. We performed biopsies in 100 consecutive patients without significant complications. The pathologic diagnostic information obtained was judged to be useful to the clinician in 54 and not useful in 46 patients. In 74 patients with congestive heart failure of unknown etiology and a dilated heart, useful pathologic diagnoses included myocarditis, vasculitis, doxorubicin cardiomyopathy, and congestive cardiomyopathy. In most of the patients with biopsy findings of myocarditis there were no other clinical or laboratory findings indicating the presence of this disease, and the diagnosis of myocarditis would have been overlooked without a biopsy. In 26 patients in whom there was clinical evidence of constrictive or restrictive cardiovascular physiologic characteristics, useful biopsy diagnoses included radiation-induced cardiomyopathy, endomyocardial fibrosis, amyloidosis, or no myocardial disease; in the patients without myocardial disease thoracotomies were performed for constrictive pericarditis. Transvenous endomyocardial biopsy can provide clinically useful information in the evaluation of diseases of the myocardium. Circulation 69, No. 1, 93-101, 1984. TRANSVENOUS endomyocardial biopsy (TEB) has been accepted as an accurate method to clinically evaluate the status of cardiac transplant rejection." 2 However, there is disagreement as to whether TEB is a useful technique in the clinical evaluation of other forms of heart disease.3'-f Nonoperative cardiac biopsy was introduced as early as 1956 and was initially performed with a transthoracic needle. In 1962 Konno introduced a transvenous biopsy catheter that allowed myocardial biopsy samples to be obtained more safely.7 "Subsequently, studies performed with modifications of the Konno catheter demonstrated that small samples of endomyocardium could be obtained with From the Cardiac Unit, Medical Services, and the Pathology Department, Massachusetts General Hospital, and the Harvard Medical School, Boston, and the Critical Care Medicine Department, Clinical Center, National Institutes of Health, Bethesda. Presented in abstract form at the Annual Meeting of the American College of Cardiology, March, 1981. Address for correspondence: Dr. Joseph E. Parrillo, Critical Care Medicine Department, National Institutes of Health, Building 10, Room 10-D-48, Bethesda, MD 20205. Received April 11, 1983; revision accepted Sept. 28, 1983. Vol. 69, No. 1, January 1984 considerable safety and reliability." 2. 12-16 However, a 1978 editorial3 reviewed the previous experience with TEB and concluded that myocardial biopsy was not useful to the clinician attempting to decide upon the appropriate diagnosis and treatment for an individual patient. These authors felt the technique was useful only in diagnosing and managing cardiac transplant rejection. To answer the question regarding the clinical usefulness of TEB, we have critically reviewed the clinical data and that obtained by biopsy from the first 100 patients who underwent TEB at the Massachusetts General Hospital over the past 7 years. For each patient the myocardial biopsy information was considered along with the clinical problem and judgments were made as to whether the biopsy added significant, useful information to the care of that patient. Our data show that when TEB is combined with a complete cardiac clinical evaluation, TEB frequently provided diagnostic information that was of major help to the clinician. 93 by gest on Sptem er 5, 2017 http://ciajournals.org/ D ow nladed from