Insensitivity of right ventricular endomyocardial biopsy in the diagnosis of myocarditis
LH Chow,
SJ Radio,
TD Sears,
and
BM McManus
Department of Pathology, University of Nebraska Medical Center, Omaha.
The clinical suspicion of myocarditis relies strongly on endomyocardial biopsy for confirmation, yet the sensitivity of the procedure in this setting has not been clearly defined. Biopsy sensitivity was determined in 14 hearts with histologically proved myocarditis studied ex vivo, including 12 autopsy hearts and 2 native hearts explanted at cardiac transplantation. With use of the Stanford and Cordis bioptomes, endoymocardial biopsy was performed near the apex on the right side of the ventricular septum (four to five samples/bioptome per patient) and repeated in the nonapical portion of the septum from the moderator band to the subpulmonary infundibulum (additional three to five samples/bioptome per patient). In a casewise assessment, 43% to 57% of the endomyocardial samples were diagnostic for myocarditis, as calculated separately for each bioptome in each region of sampling (apical/nonapical). Both apical and nonapical sensitivity improved to 64% when the findings of the two bioptomes were combined (eight to nine samples/patient in each region). By collectively analyzing all available samples for each patient, 11 (79%) of 14 cases could be diagnosed, but this required a mean of 17.2 samples/patient, a number clinically unrealistic. The exclusion of four cases of fungal myocarditis from analysis did not significantly alter the results. In transmural ventricular sections, none of four patients with sudden death had inflammatory disease confined to the conduction system. In conclusion, despite six to eight negative biopsy samples/patient with suspected myocarditis, repeat biopsy may still be warranted.
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D. H. O'Donnell, S. Abbara, V. Chaithiraphan, K. Yared, R. P. Killeen, R. Martos, D. Keane, R. C. Cury, and J. D. Dodd
Cardiac MR Imaging of Nonischemic Cardiomyopathies: Imaging Protocols and Spectra of Appearances
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February 1, 2012;
262(2):
403 - 422.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
M. G. Friedrich, U. Sechtem, J. Schulz-Menger, G. Holmvang, P. Alakija, L. T. Cooper, J. A. White, H. Abdel-Aty, M. Gutberlet, S. Prasad, et al.
Cardiovascular Magnetic Resonance in Myocarditis: A JACC White Paper
J. Am. Coll. Cardiol.,
April 28, 2009;
53(17):
1475 - 1487.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
I. Kindermann, M. Kindermann, R. Kandolf, K. Klingel, B. Bultmann, T. Muller, A. Lindinger, and M. Bohm
Predictors of Outcome in Patients With Suspected Myocarditis
Circulation,
August 5, 2008;
118(6):
639 - 648.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
H Abdel-Aty, N Siegle, A Natusch, E Gromnica-Ihle, R Wassmuth, R Dietz, and J Schulz-Menger
Myocardial tissue characterization in systemic lupus erythematosus: value of a comprehensive cardiovascular magnetic resonance approach
Lupus,
June 1, 2008;
17(6):
561 - 567.
[Abstract]
[PDF]
|
 |
|

|
 |

|
 |
 
R. G. Assomull, J. C. Lyne, N. Keenan, A. Gulati, N. H. Bunce, S. W. Davies, D. J. Pennell, and S. K. Prasad
The role of cardiovascular magnetic resonance in patients presenting with chest pain, raised troponin, and unobstructed coronary arteries
Eur. Heart J.,
May 3, 2007;
(2007)
ehm113v1.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
H. N. Skouri, G. W. Dec, M. G. Friedrich, and L. T. Cooper
Noninvasive Imaging in Myocarditis
J. Am. Coll. Cardiol.,
November 21, 2006;
48(10):
2085 - 2093.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
K. L. Baughman
Diagnosis of Myocarditis: Death of Dallas Criteria
Circulation,
January 31, 2006;
113(4):
593 - 595.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
W G Law, B Y Thong, T Y Lian, K O Kong, and H H Chng
Acute lupus myocarditis: clinical features and outcome of an oriental case series
Lupus,
October 1, 2005;
14(10):
827 - 831.
[Abstract]
[PDF]
|
 |
|

|
 |

|
 |
 
H. Abdel-Aty, P. Boye, A. Zagrosek, R. Wassmuth, A. Kumar, D. Messroghli, P. Bock, R. Dietz, M. G. Friedrich, and J. Schulz-Menger
Diagnostic Performance of Cardiovascular Magnetic Resonance in Patients With Suspected Acute Myocarditis: Comparison of Different Approaches
J. Am. Coll. Cardiol.,
June 7, 2005;
45(11):
1815 - 1822.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
M G. Gagliardi, M Bevilacqua, C Bassano, B Leonardi, R Boldrini, F D. Camassei, A Fierabracci, A G Ugazio, and G F Bottazzo
Long term follow up of children with myocarditis treated by immunosuppression and of children with dilated cardiomyopathy
Heart,
October 1, 2004;
90(10):
1167 - 1171.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
K. U. Knowlton and T. Yajima
Interleukin-10: Biomarker or pathologic cytokine in fulminant myocarditis?
J. Am. Coll. Cardiol.,
September 15, 2004;
44(6):
1298 - 1300.
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
C. Peker, L. Sarda-Mantel, P. Loiseau, F. Rouzet, L. Nazneen, G. Martet, J.-M. Vrigneaud, A. Meulemans, G. Saumon, J.-B. Michel, et al.
Imaging Apoptosis with 99mTc-Annexin-V in Experimental Subacute Myocarditis
J. Nucl. Med.,
June 1, 2004;
45(6):
1081 - 1086.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
F. Calabrese and G. Thiene
Myocarditis and inflammatory cardiomyopathy: microbiological and molecular biological aspects
Cardiovasc Res,
October 15, 2003;
60(1):
11 - 25.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
N. E. Bowles, J. Ni, D. L. Kearney, M. Pauschinger, H.-P. Schultheiss, R. McCarthy, J. Hare, J. T. Bricker, K. R. Bowles, and J. A. Towbin
Detection of viruses in myocardial tissues by polymerase chain reaction: evidence of adenovirus as a common cause of myocarditis in children and adults
J. Am. Coll. Cardiol.,
August 6, 2003;
42(3):
466 - 472.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
R. Wojnicz, E. Nowalany-Kozielska, C. Wojciechowska, G. Glanowska, P. Wilczewski, T. Niklewski, M. Zembala, L. Polonski, M. M. Rozek, and J. Wodniecki
Randomized, Placebo-Controlled Study for Immunosuppressive Treatment of Inflammatory Dilated Cardiomyopathy : Two-Year Follow-Up Results
Circulation,
July 3, 2001;
104(1):
39 - 45.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
L. Sarda, P. Colin, F. Boccara, D. Daou, R. Lebtahi, M. Faraggi, C. Nguyen, A. Cohen, M. S. Slama, P. G. Steg, et al.
Myocarditis in patients with clinical presentation of myocardial infarction and normal coronary angiograms
J. Am. Coll. Cardiol.,
March 1, 2001;
37(3):
786 - 792.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
A. Frustaci, C. Chimenti, and M. Pieroni
Prognostic Significance of Left Ventricular Aneurysms With Normal Global Function Caused by Myocarditis
Chest,
December 1, 2000;
118(6):
1696 - 1702.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
A. F. L. Schinkel, J. J. Bax, E. E. van der Wall, and G. J. P. M. Jonkers
Echocardiographic Follow-up of Chlamydia psittaci Myocarditis
Chest,
April 1, 2000;
117(4):
1203 - 1205.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
G. D. Pearson, J.-C. Veille, S. Rahimtoola, J. Hsia, C. M. Oakley, J. D. Hosenpud, A. Ansari, and K. L. Baughman
Peripartum Cardiomyopathy: National Heart, Lung, and Blood Institute and Office of Rare Diseases (National Institutes of Health) Workshop Recommendations and Review
JAMA,
March 1, 2000;
283(9):
1183 - 1188.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
B. Lauer, M. Schannwell, U. Kuhl, B.-E. Strauer, and H.-P. Schultheiss
Antimyosin autoantibodies are associated with deterioration of systolic and diastolic left ventricular function in patients with chronic myocarditis
J. Am. Coll. Cardiol.,
January 1, 2000;
35(1):
11 - 18.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
R. Houel, E. Vermes, D. B. Tixier, P. Le Besnerais, N. Benhaiem-Sigaux, and D. Y. Loisance
Myocardial recovery after mechanical support for acute myocarditis: is sustained recovery predictable?
Ann. Thorac. Surg.,
December 1, 1999;
68(6):
2177 - 2180.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
K J Lee, B W McCrindle, D J Bohn, G J Wilson, G P Taylor, R M Freedom, J F Smallhorn, and L N Benson
Clinical outcomes of acute myocarditis in childhood
Heart,
August 1, 1999;
82(2):
226 - 233.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
M. Pauschinger, N. E. Bowles, F. J. Fuentes-Garcia, V. Pham, U. Kuhl, P. L. Schwimmbeck, H.-P. Schultheiss, and J. A. Towbin
Detection of Adenoviral Genome in the Myocardium of Adult Patients With Idiopathic Left Ventricular Dysfunction
Circulation,
March 16, 1999;
99(10):
1348 - 1354.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
L Sarda, P Assayag, E Palazzo, D Vilain, L Guillevin, M Faraggi, O Meyer, and D Le Guludec
111Indium antimyosin antibody imaging of primary myocardial invovement in systemic diseases
Ann Rheum Dis,
February 1, 1999;
58(2):
90 - 95.
[Abstract]
[Full Text]
|
 |
|

|
 |

|
 |
 
U. Kuhl, B. Lauer, M. Souvatzoglu, H. Vosberg, and H.-P. Schultheiss
Antimyosin scintigraphy and immunohistologic analysis of endomyocardial biopsy in patients with clinically suspected myocarditis--evidence of myocardial cell damage and inflammation in the absence of histologic signs of myocarditis
J. Am. Coll. Cardiol.,
November 1, 1998;
32(5):
1371 - 1376.
[Abstract]
[Full Text]
[PDF]
|
 |
|

|
 |

|
 |
 
K. O. Schowengerdt, J. Ni, S. W. Denfield, R. J. Gajarski, N. E. Bowles, G. Rosenthal, D. L. Kearney, J. K. Price, B. B. Rogers, G. M. Schauer, et al.
Association of Parvovirus B19 Genome in Children With Myocarditis and Cardiac Allograft Rejection : Diagnosis Using the Polymerase Chain Reaction
Circulation,
November 18, 1997;
96(10):
3549 - 3554.
[Abstract]
[Full Text]
|
 |
|

|
 |

|
 |
 
P. Chevalier, F. Vandenesch, P. Brouqui, G. Kirkorian, A. Tabib, J. Etienne, D. Raoult, R. Loire, and P. Touboul
Fulminant Myocardial Failure in a Previously Healthy Young Man
Circulation,
March 18, 1997;
95(6):
1654 - 1657.
[Full Text]
|
 |
|

|
 |

|
 |
 
D. Th. Kremastinos, G. Tiniakos, G. N. Theodorakis, D. G. Katritsis, and P. K. Toutouzas
Myocarditis in -Thalassemia Major : A Cause of Heart Failure
Circulation,
January 1, 1995;
91(1):
66 - 71.
[Abstract]
[Full Text]
|
 |
|
|