Skip to main content
Top
Published in: Virchows Archiv 1/2013

01-07-2013 | Review and Perspectives

Diagnostic use of the endomyocardial biopsy: a consensus statement

Authors: Gaetano Thiene, Patrick Bruneval, John Veinot, Ornella Leone

Published in: Virchows Archiv | Issue 1/2013

Login to get access

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.
Literature
1.
go back to reference 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, 2012PubMedCrossRef 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, 2012PubMedCrossRef
2.
go back to reference 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 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
4.
go back to reference 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 9:587–593PubMed 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 9:587–593PubMed
5.
go back to reference 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 3:171–178PubMedCrossRef 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 3:171–178PubMedCrossRef
6.
go back to reference Ferrans VJ, Roberts WC (1978) Myocardial biopsy: a useful diagnostic procedure or only a research tool? Am J Cardiol 41:965–967PubMedCrossRef Ferrans VJ, Roberts WC (1978) Myocardial biopsy: a useful diagnostic procedure or only a research tool? Am J Cardiol 41:965–967PubMedCrossRef
7.
go back to reference 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 1:3–14PubMed 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 1:3–14PubMed
8.
go back to reference 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 333:269–275PubMedCrossRef 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 333:269–275PubMedCrossRef
9.
10.
go back to reference 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 118:1722–1728PubMedCrossRef 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 118:1722–1728PubMedCrossRef
11.
go back to reference 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 122:900–909CrossRef 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 122:900–909CrossRef
12.
go back to reference 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 4:1142–1148PubMedCrossRef 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 4:1142–1148PubMedCrossRef
13.
go back to reference 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 116:2216–2233PubMedCrossRef 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 116:2216–2233PubMedCrossRef
14.
go back to reference 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 28:1326–1333PubMedCrossRef 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 28:1326–1333PubMedCrossRef
15.
go back to reference Veinot JP (2009) Diagnostic endomyocardial biopsy—still useful after all these years. Can J Cardiol 25:e55–e56PubMedCrossRef Veinot JP (2009) Diagnostic endomyocardial biopsy—still useful after all these years. Can J Cardiol 25:e55–e56PubMedCrossRef
16.
go back to reference 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 8:17–23PubMedCrossRef 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 8:17–23PubMedCrossRef
17.
go back to reference 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 29:2760–2771PubMedCrossRef 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 29:2760–2771PubMedCrossRef
18.
go back to reference 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 336:1860–1866PubMedCrossRef 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 336:1860–1866PubMedCrossRef
19.
go back to reference 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 735–762CrossRef 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 735–762CrossRef
20.
go back to reference 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 90:791–798PubMedCrossRef 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 90:791–798PubMedCrossRef
21.
go back to reference 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 121:1533–1541PubMedCrossRef 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 121:1533–1541PubMedCrossRef
22.
go back to reference Schultheiss HP, Kuhl U, Cooper LT (2011) The management of myocarditis. Eur Heart J 32:2618–2625CrossRef Schultheiss HP, Kuhl U, Cooper LT (2011) The management of myocarditis. Eur Heart J 32:2618–2625CrossRef
23.
go back to reference 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 84:245–250PubMedCrossRef 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 84:245–250PubMedCrossRef
24.
go back to reference Calabrese F, Thiene G (2003) Myocarditis and inflammatory cardiomyopathy: microbiological and molecular biological aspects. Cardiovasc Res 60:11–25PubMedCrossRef Calabrese F, Thiene G (2003) Myocarditis and inflammatory cardiomyopathy: microbiological and molecular biological aspects. Cardiovasc Res 60:11–25PubMedCrossRef
25.
go back to reference Frustaci A, Chimenti C, Calabrese F, Pieroni M, Thiene G, Maseri A (2003) Immunosuppressive therapy for active lymphocytic myocarditis. Circulation 107:857–863PubMedCrossRef Frustaci A, Chimenti C, Calabrese F, Pieroni M, Thiene G, Maseri A (2003) Immunosuppressive therapy for active lymphocytic myocarditis. Circulation 107:857–863PubMedCrossRef
26.
go back to reference 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 22:214–217PubMedCrossRef 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 22:214–217PubMedCrossRef
27.
go back to reference 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 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
28.
go back to reference 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 17:1108–1118PubMedCrossRef 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 17:1108–1118PubMedCrossRef
29.
go back to reference Bock CT, Klingel K, Kandolf R (2010) Human parvovirus B19-associated myocarditis. N Engl J Med 362:1248–1249PubMedCrossRef Bock CT, Klingel K, Kandolf R (2010) Human parvovirus B19-associated myocarditis. N Engl J Med 362:1248–1249PubMedCrossRef
30.
go back to reference 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 123:1174–1184PubMedCrossRef 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 123:1174–1184PubMedCrossRef
31.
go back to reference 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 51:731–739PubMedCrossRef 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 51:731–739PubMedCrossRef
32.
go back to reference 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 19:1127–1134PubMedCrossRef 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 19:1127–1134PubMedCrossRef
33.
go back to reference 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 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
Metadata
Title
Diagnostic use of the endomyocardial biopsy: a consensus statement
Authors
Gaetano Thiene
Patrick Bruneval
John Veinot
Ornella Leone
Publication date
01-07-2013
Publisher
Springer Berlin Heidelberg
Published in
Virchows Archiv / Issue 1/2013
Print ISSN: 0945-6317
Electronic ISSN: 1432-2307
DOI
https://doi.org/10.1007/s00428-013-1430-4

Other articles of this Issue 1/2013

Virchows Archiv 1/2013 Go to the issue