Skip to main content
SpringerLink
Log in

Diagnostic use of the endomyocardial biopsy: a consensus statement

  • Review and Perspectives
  • Published:
Virchows Archiv Aims and scope Submit manuscript

Abstract

The Association for European Cardiovascular Pathology and the Society for Cardiovascular Pathology created a task force to write a consensus document on when and how endomyocardial biopsy is of help for clinicians in the diagnosis and treatment of patients with heart failure, arrhythmias, and cardiac masses. Endomyocardial biopsy is the gold standard for a definitive diagnosis in disease entities like myocarditis, cardiac allograft rejection, and infiltration/storage myocardial disorders. Use of molecular biology techniques is mandatory to obtain specific information on etiology and pathogenesis and should be carried out as an investigation complementary to histology and immunohistochemistry. Given the complexity of these investigations, endomyocardial biopsy should be performed in or in collaboration with cardiac pathology referral centers, where the whole armamentarium of pathological investigation is available, including molecular techniques. Optimal use of the endomyocardial biopsy requires clinicopathologic correlations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Leone O, Veinot JP, Angelini A, Baandrup UT, Basso C, Berry G, Bruneval P, Burke M, Butany J, Calabrese F, d'Amati G, Edwards WD, Fallon JT, Fishbein MC, Gallagher PJ, Halushka MK, McManus B, Pucci A, Rodriguez ER, Saffitz JE, Sheppard MN, Steenbergen C, Stone JR, Tan C, Thiene G, van der Wal AC, Winters GL (2011) Consensus statement on endomyocardial biopsy from the Association for European Cardiovascular Pathology and the Society for Cardiovascular Pathology. Cardiovasc Pathol 21:245–274, 2012

    Article  PubMed  Google Scholar 

  2. Leone O, Rapezzi C, Sinagra G, Angelini A, Arbustini E, Bartoloni G, Basso C, Caforio ALP, Calabrese F, Coccolo F, d’Amati G, Maresi E, Milanesi O, Nodari S, Oliva F, Perkan A, Prandstraller D, Pucci A, Ramondo A, Silvestri F, Valente M, Thiene G (2009) Documento di consenso sulla biopsia endomiocardica promosso dall’Associazione per la Patologia Cardiovascolare Italiana. G Ital Cardiol 10(suppl 1–9):3S–50S

    Google Scholar 

  3. Sakakibara S, Konno S (1962) Endomyocardial biopsy. Jpn Heart J 3:537–543

    Article  PubMed  CAS  Google Scholar 

  4. Billingham ME, Cary NR, Hammond ME, Kemnitz J, Marboe C, McCallister HA, Snovar DC, Winters GL, Zerbe A (1990) A working formulation for the standardization of nomenclature in the diagnosis of heart and lung rejection: Heart Rejection Study Group. The International Society for Heart Transplantation. J Heart Transplant 9:587–593

    PubMed  CAS  Google Scholar 

  5. Baandrup U, Florio RA, Olsen EG (1982) Do endomyocardial biopsies represent the morphology of the rest of the myocardium? A quantitative light microscopic study of single v. multiple biopsies with the King’s bioptome. Eur Heart J 3:171–178

    Article  PubMed  CAS  Google Scholar 

  6. Ferrans VJ, Roberts WC (1978) Myocardial biopsy: a useful diagnostic procedure or only a research tool? Am J Cardiol 41:965–967

    Article  PubMed  CAS  Google Scholar 

  7. Aretz HT, Billingham ME, Edwards WD, Factor SM, Fallon JT, Fenoglio JJ Jr, Olsen EG, Schoen FJ (1987) Myocarditis: a histopathologic definition and classification. Am J Cardiovasc Pathol 1:3–14

    PubMed  CAS  Google Scholar 

  8. Mason JW, O'Connell JB, Herskowitz A, Rose NR, McManus B, Billingham ME, Moon TE, the Myocarditis Treatment Trial Investigators (1995) A clinical trial of immunosuppressive therapy for myocarditis. N Engl J Med 333:269–275

    Article  PubMed  CAS  Google Scholar 

  9. Baughman KL (2006) Diagnosis of myocarditis—death of Dallas criteria. Circulation 113:593–595

    Article  PubMed  Google Scholar 

  10. Holzmann M, Nicko A, Kuhl U, Noutsias M, Poller W, Hoffmann, Morguet A, Witzenbichler B, Tschope C, Schultheiss HP, Paushinger M (2008) Complication rate of right ventricular endomyocardial biopsy via the femoral approach—a retrospective and prospective study analyzing 3048 diagnostic procedures over an 11-year period. Circulation 118:1722–1728

    Article  PubMed  Google Scholar 

  11. Ylmaz A, Kindermann I, Kindermann M, Mahfoud F, Ukena C, Athanasiadis A, Hill S, Mahrholdt H, Voehringer M, Schieber M, Klingel K, Kandolf R, Bohm M, Sechtem U (2010) Comparative evaluation of left and right ventricular endomyocardial biopsy. Differences in complication rate and diagnostic performance. Circulation 122:900–909

    Article  Google Scholar 

  12. Paul M, Stypmann J, Gerss J, Wirdeier S, Zumhagen S, Breithardt G, Schulze-Bahr E, Wichter T (2011) Safety of endomyocardial biopsy in patients with arrhythmogenic right ventricular cardiomyopathy. JACC Cardiovasc Interv 4:1142–1148

    Article  PubMed  Google Scholar 

  13. Cooper LT, Baughman KL, Feldman AM, Frustaci A, Jessup M, Kuhl U, Levine GN, Narula J, Starling RC, Towbin J, Virmani R, endorsed by the Heart Failure Society of America and the Heart Failure Association of the European Society of Cardiology (2007) The role of endomyocardial biopsy in the management of cardiovascular disease—a scientific statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology. Circulation 116:2216–2233

    Article  PubMed  Google Scholar 

  14. Caforio AL, Calabrese F, Angelini A, Tona F, Vinci A, Bottaro S, Ramondo A, Carturan E, Iliceto S, Thiene G, Daliento L (2007) A prospective study of biopsy-proven myocarditis: prognostic relevance of clinical and aetiopathogenetic features at diagnosis. Eur Heart J 28:1326–1333

    Article  PubMed  Google Scholar 

  15. Veinot JP (2009) Diagnostic endomyocardial biopsy—still useful after all these years. Can J Cardiol 25:e55–e56

    Article  PubMed  Google Scholar 

  16. Angelini A, Boffa GM, Livi U, Barchitta A, Casarotto D, Thiene G (1999) Discordance between pre and post cardiac transplant diagnosis: implications for pre- and postoperative decision making. Cardiovasc Pathol 8:17–23

    Article  PubMed  CAS  Google Scholar 

  17. Basso C, Ronco F, Marcus F, Abudureheman A, Rizzo S, Frigo AC, Bauce B, Maddalena F, Nava A, Corrado D, Grigoletto F, Thiene G (2008) Quantitative assessment of endomyocardial biopsy in arrhythmogenic right ventricular cardiomyopathy/dysplasia: an in vitro validation of diagnostic criteria. Eur Heart J 29:2760–2771

    Article  PubMed  Google Scholar 

  18. Cooper LT, Berry GJ, Shabetai R (1997) Idiopathic giant-cell myocarditis—natural history and treatment. Multicenter Giant Cell Myocarditis Study Group Investigators. N Engl J Med 336:1860–1866

    Article  PubMed  Google Scholar 

  19. Thiene G, Valente M, Lombardi M, Basso C (2009) Tumours of the heart. In: Camm AJ, Luscher TF, Serruys PW (eds) ESC textbook of cardiovascular medicine. Oxford University Press, Oxford, pp 735–762

    Chapter  Google Scholar 

  20. Fedrigo M, Gambino A, Tona F, Torregrossa G, Poli F, Benazzi E, Frigo A, Feltrin G, Toscano G, Caforio AP, Iliceto S, Valente M, Thiene G, Gerosa G, Angelini A (2010) Can C4d immunostaining on endomyocardial biopsies be considered a prognostic biomarker in heart transplant recipients? Transplantation 90:791–798

    Article  PubMed  CAS  Google Scholar 

  21. Marcus FI, McKenna WJ, Sherrill D, Basso C, Bauce B, Bluemke DA, Calkins H, Corrado D, Cox MG, Daubert JP, Fontaine G, Gear K, Hauer R, Nava A, Picard MH, Protonotarios N, Saffitz JE, Sanborn DM, Steinberg JS, Tandri H, Thiene G, Towbin JA, Tsatsopoulou A, Wichter T, Zareba W (2010) Diagnosis of arrhythmogenic right ventricular cardiomyopathy/dysplasia: proposed modification of the task force criteria. Circulation 121:1533–1541

    Article  PubMed  Google Scholar 

  22. Schultheiss HP, Kuhl U, Cooper LT (2011) The management of myocarditis. Eur Heart J 32:2618–2625

    Article  Google Scholar 

  23. Angelini A, Calzolari V, Calabrese F, Boffa GM, Maddalena F, Chioin R, Thiene G (2000) Myocarditis mimicking acute myocardial infarction: role of endomyocardial biopsy in the differential diagnosis. Heart 84:245–250

    Article  PubMed  CAS  Google Scholar 

  24. Calabrese F, Thiene G (2003) Myocarditis and inflammatory cardiomyopathy: microbiological and molecular biological aspects. Cardiovasc Res 60:11–25

    Article  PubMed  CAS  Google Scholar 

  25. Frustaci A, Chimenti C, Calabrese F, Pieroni M, Thiene G, Maseri A (2003) Immunosuppressive therapy for active lymphocytic myocarditis. Circulation 107:857–863

    Article  PubMed  Google Scholar 

  26. Daliento L, Calabrese F, Tona F, Caforio ALP, Tarsia G, Angelini A, Thiene G (2003) Successful treatment of enterovirus-induced myocarditis with interferon-α. J Heart Lung Transplant 22:214–217

    Article  PubMed  Google Scholar 

  27. Asimaki A, Tandri H, Huang H, Halushka MK, Gautam S, Basso C, Thiene G, Tsatsopoulou A, Protonotarios N, McKenna WJ, Calkins H, Saffitz JE (2009) A new diagnostic test for arrhythmogenic right ventricular cardiomyopathy. N Engl J Med 360:1075–1084

    Google Scholar 

  28. Calabrese F, Carturan E, Chimenti C, Pieroni M, Agostini C, Angelini A (2004) Overexpression of tumor necrosis factor (TNF) alpha and TNF alpha receptor I in human viral myocarditis: clinicopathologic correlations. Mod Pathol 17:1108–1118

    Article  PubMed  CAS  Google Scholar 

  29. Bock CT, Klingel K, Kandolf R (2010) Human parvovirus B19-associated myocarditis. N Engl J Med 362:1248–1249

    Article  PubMed  CAS  Google Scholar 

  30. Heidecker B, Kittleson MM, Kasper EK, Wittstein IS, Champion HC, Russel SD, Hruban RH, Rodriguez ER, Baughman KL, Hare JM (2011) Transcriptomic biomarkers for the accurate diagnosis of myocarditis. Circulation 123:1174–1184

    Article  PubMed  CAS  Google Scholar 

  31. Corrado D, Basso C, Leoni L, Tokajuk B, Turrini P, Bauce B, Migliore F, Pavei A, Tarantini G, Napodano M, Ramondo A, Buja G, Iliceto S, Thiene G (2008) Three-dimensional electroanatomical voltage mapping and histologic evaluation of myocardial substrate in right ventricular outflow tract tachycardia. J Am Coll Cardiol 51:731–739

    Article  PubMed  Google Scholar 

  32. Avella A, d'Amati G, Pappalardo A, Re F, Silenzi PF, Laurenzi F, DE Girolamo P, Pelargonio G, Dello Russo A, Baratta P, Messina G, Zecchi P, Zachara E, Tondo C (2008) Diagnostic value of endomyocardial biopsy guided by electroanatomic voltage mapping in arrhythmogenic right ventricular cardiomyopathy/dysplasia. J Cardiovasc Electrophysiol 19:1127–1134

    Article  PubMed  Google Scholar 

  33. Thiene G, Veinot JP, Angelini A, Baandrup UT, Basso C, Bruneval P, Buja LM, Butany J, d'Amati G, de Gouveia RH, Fallon JT, Fishbein MC, Gallagher PJ, Kholova I, Leone O, McManus B, Rodriguez ER, Schoen FJ, Sheppard MN, Stone JR, van der Wal AC, Winters GL (2010) AECVP and SCVP 2009 recommendations for training in cardiovascular pathology. Cardiovasc Pathol 19:129–135

Download references

Conflict of interest

We declare that we have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Cardiological, Thoracic and Vascular Sciences, University of Padua, Via A. Gabelli, 61, 35121, Padua, Italy

    Gaetano Thiene

  2. Department of Pathology, Hopital European Georges Pompidou, Paris, France

    Patrick Bruneval

  3. Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, Canada

    John Veinot

  4. Department of Pathology, S. Orsola Malpighi Hospital, Bologna, Italy

    Ornella Leone

Authors
  1. Gaetano Thiene
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Patrick Bruneval
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. John Veinot
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ornella Leone
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gaetano Thiene.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Thiene, G., Bruneval, P., Veinot, J. et al. Diagnostic use of the endomyocardial biopsy: a consensus statement. Virchows Arch 463, 1–5 (2013). https://doi.org/10.1007/s00428-013-1430-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00428-013-1430-4

Keywords

Search

Navigation