Photo Credit: Jeniffer Fontan

The following is a summary of “Endomyocardial biopsy in patients with myocarditis—still justified in the CMR era? A single-centre experience,” published in the November 2024 issue of Cardiology by Seuthe et al.       

Cardiovascular magnetic resonance (CMR) has become a non-invasive diagnostic tool for myocarditis, leading to hesitation in performing endomyocardial biopsy (EMB) due to potential complications.  

Researchers conducted a retrospective study to identify patient subgroups that could benefit from EMB in the CMR era.  

They analyzed data from patients with myocarditis (January 2016 and June 2023), considering risk factors such as left ventricular ejection fraction (LVEF) ≤ 30%, severe arrhythmias, or pre-existing autoimmune disease, and recurrent myocarditis cases were analyzed separately.  

The results showed 137 patients (mean age 35.5 years, 80.3% male), with 26 having LVEF ≤ 30%, 13 having LVEF > 30% and at least 1 risk factor, and 98 having LVEF > 30% without risk factors. The EMB was performed in 21 of 26 patients with LVEF ≤ 30% (80.8%), in 7 of 13 with LVEF > 30% and risk factors (53.8%), and in 16 of 98 patients without risk factors (16%), EMB led to immunosuppressive therapy initiation in 11 of 28 patients with risk factors (39.3%), but in none of the patients without risk factors (0 of 16, P=0.003). No specific therapy was initiated for patients with recurrent myocarditis (n = 10).  

They concluded that EMB should be considered for high-risk patients with myocarditis, as this aids in initiating immunosuppressive therapy but offers limited benefit for those without risk factors.  

Source: link.springer.com/article/10.1007/s00392-024-02574-4