Abstract
Myocarditis, an inflammatory disease of the heart, frequently results from viral infections, postviral immune-mediated responses, or both. It is a common cause of acute-onset systolic heart failure in children. Endomyocardial biopsy (EMB) remains the gold standard for the diagnosis of myocarditis. However, EMB is not performed for most myocarditis cases involving children in the United States. Clinical scenarios in which EMB results added unique prognostic data and guidance to therapy have been defined recently. This review outlines the role of EMB in the diagnosis and management of myocarditis for children presenting with acute-onset systolic heart failure.
Similar content being viewed by others
References
Angelini A, Calzolaari V, 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
Aretz HT, Billingham ME, Edwards WD et al (1987) Myocarditis: a histopathological definition and classification. Am J Cardiovasc Pathol 1:3–14
Baughman KL (2006) Diagnosis of myocarditis: death of Dallas criteria. Circulation 113:593–595
Blauwet LA, Cooper LT (2010) Myocarditis. Prog Cardiovasc Dis 52:274–288
Breinholt JP, Moulik M, Dreyer WJ et al (2010) Viral epidemiologic shift in inflammatory heart disease: the interesting involvement of parvovirus B19 in the myocardium of pediatric cardiac transplant patients. J Heart Lung Transplant 29:739–746
Chow LH, Radio SJ, Sears TD, McManus BM (1989) Insensitivity of right ventricular endomyocardial biopsy in the diagnosis of myocarditis. J Am Coll Cardiol 14:915–920
Cooper LT, Baughman KL, Feldman AM et al (2007) AHA/ACCF/ESC scientific statement: the role of endomyocardial biopsy in the management of cardiovascular disease. Circulation 50:1914–1931
Crossland DS, Edmonds K, Rassl D et al (2008) Histology of explanted hearts in children transplanted for dilated cardiomyopathy. Pediatr Transplant 12:85–90
Daly KP, Marshall AC, Vincent JA et al (2012) Endomyocardial biopsy and selective coronary angiography are low-risk procedures in pediatric heart transplant recipients: results of a multicenter experience. J Heart Lung Transplant 31:398–409
D’Ambrosio A, Patti G, Mazoli A et al (2001) The fate of acute myocarditis between spontaneous improvement and evolution to dilated cardiomyopathy: a review. Heart 85:499–504
Daubency PE, Nugent AW, Chondors P, National Australian Childhood Cardiomyopathy Study et al (2006) Clinical features and outcomes of childhood dilated cardiomyopathy: results from a national population-based study. Circulation 114:2671–2678
Dennert R, Crijns HJ, Heyman S (2008) Acute viral myocarditis. Eur Heart J 29:2073–2082
Felker GM, Boehmer JP, Hruban RH et al (2000) Echocardiographic findings in fulminant and acute myocarditis. J Am Coll Cardiol 36:227–232
Foerster SR, Canter CE, Cinar A et al (2010) Ventricular remodeling and survival are more favorable for myocarditis than for idiopathic cardiomyopathy in childhood: an outcome study from the pediatric cardiomyopathy registry. Circ Heart Fail 3:689–697
Friedrich MG, Sechtem U, Shulz-Menger J et al (2009) Cardiovascular magnetic resonance in myocarditis: a JACC white paper. International Sensus Group on Cardiovascular Magnetic Resonance in Myocarditis. J Am Coll Cardiol 53:1475–1487
Freimuth P, Philipson L, Carson SD (2008) The Coxsackie virus and adenovirus receptor. Curr Top Microbiol Immunol 323:67–87
Frustaci A, Chimenti C, Calabrese F, Pieroni M, Thiene G, Maseri A (2003) Immunosuppressive therapy for active lymphocytic myocarditis: virological and immunological profile of responders versus nonresponders. Circulation 107:857–863
Frustaci A, Russo MA, Chimenti C (2009) Randomized study on the efficacy of immunosuppressive therapy in patients with virus-negative inflammatory cardiomyopathies: the TIMC study. Eur Heart J 30:1995–2002
Gagliardi MG, Bevilacqua M, Di Renzi P, Picardo S, Passariello R, Marcelletti C (1991) Usefulness of magnetic resonance imaging for diagnosis of acute myocarditis in infants and children, and comparison with endomyocardial biopsy. Am J Cardiol 68:1089–1091
Hauck AJ, Kearney DL, Edwards WD (1989) Evaluation of postmortem endomyocardial biopsy specimens from 38 patients with lymphocytic myocarditis: implications for the role of sampling error. Mayo Clin Proc 64:1235–1245
Hill KD, Atkinson JB, Doyle TP, Dodd D (2009) Routine performance of endomyocardial biopsy decreases the incidence of orthotopic heart transplant for myocarditis. J Heart Lung Transplant 26:1261–1266
Jessup M, Abraham WT, Casey DE et al (2009) 2009 Focused Update: ACCF/AHA guidelines for the diagnosis and management of heart failure in adults: a report of the ACCCF/AHA Task Force on Practice Guidelines: Developed in Collaboration with ISHLT. Circulation 119:1977–2016
Kinderman I, Kinderman M, Kandolf R et al (2008) Predictors of outcome in patients with suspected myocarditis. Circulation 118:639–648
Kuhl U, Lauer B, Souvatzoglu M, Vosberg H, Schultheiss HP (1998) 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 histological signs of myocarditis. J Am Coll Cardiol 32:1371–1376
Lee KJ, McCrindle BW, Bohn DJ et al (1999) Clinical outcomes of acute myocarditis in childhood. Heart 82:226–233
Lie JT (1988) Myocarditis and endomyocardial biopsy in unexplained heart failure: a diagnosis in search of a disease (editorial). Ann Intern Med 109:525–528
Liu PP, Mason JW (2001) Advances in the understanding of myocarditis. Circulation 104:1076–1082
Martin AB, Webber S, Fricker FJ et al (1994) Acute myocarditis: rapid diagnosis by PCR in children. Circulation 90:330–339
Mason JW, O’Connell JB, Herskowtiz A et al (1995) A clinical trial of immunosuppressive therapy for myocarditis: the myocarditis treatment trial investigators. N Engl J Med 333:269–275
McNamara DM, Holubkov R, Starling RC et al (2001) Controlled trial of intravenous immune globulin in recent-onset cardiomyopathy. Circulation 103:2254–2259
Mendes LA, Dec GW, Picard MH, Palacios IF, Newell J, Davidoff R (1994) Right ventricular dysfunction: an independent predictor of adverse outcome in patients with myocarditis. Am Heart J 128:301–307
Pietra BA, Kantor PF, Bartlett HL et al (2012) Early predictors of survival to and after heart transplantation in children with dilated cardiomyopathy. Circulation 126:1079–1086
Pophal SG, Sigfusson G, Booth KL et al (1999) Complications of endomyocardial biopsy in children. J Am Coll Cardiol 34:2105–2110
Richardson P, McKenna W, Bristow M et al (1996) Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of Cardiomyopathies. Circulation 93:841–842
Schmaltz AA, Apitz J, Hort W, Maisch B (1990) Endomyocardial biopsy in infants and children: experience in 60 patients. Pediatr Cardiol 11:15–21
Schultz JC, Hilliard AA, Cooper LT Jr, Rihal CS (2009) Diagnosis and treatment of viral myocarditis. Mayo Clin Proc 84:1001–1009
Stanton C, Mookadam F, Cha S et al (2008) Greater symptom duration predicts response to immunomodulatory therapy in dilated cardiomyopathy. Int J Cardiol 128:38–41
Wojnicz R, Nowalany-Kozielska E, Wojciechowska C et al (2001) Randomized, placebo-controlled study for immunosuppressive treatment of inflammatory dilated cardiomyopathy: two-year follow-up results. Circulation 104:39–45
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Das, B.B. Role of Endomyocardial Biopsy for Children Presenting With Acute Systolic Heart Failure. Pediatr Cardiol 35, 191–196 (2014). https://doi.org/10.1007/s00246-013-0807-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00246-013-0807-0