Endomyocardial biopsy (EMB) is a diagnostic tool for evaluating various cardiac conditions, such as myocarditis and myocardial infiltrative diseases. It is also the gold standard screening technique for detecting allograft rejection after heart transplantation. Despite advances in noninvasive imaging modalities for myocardial tissue characterization, EMB is still necessary for making a definitive diagnosis and determining treatment for certain conditions. Herein, we report our recent experience using EMB and its diagnostic yield. We retrospectively reviewed EMBs performed at our institution from March 2018 through March 2023. Clinical data, including patient characteristics, indication and diagnostic yield of EMB, and procedure-related complications, were collected. Histopathological findings of the biopsies were recorded and classified based on the degree to which they matched the clinical diagnosis and cardiac magnetic resonance imaging (CMR) findings. A total of 212 EMBs obtained in 178 consecutive patients were retrospectively analyzed, with 42 biopsies performed for allograft rejection surveillance (10 patients) and the remaining performed for presumptive diagnosis of acute myocarditis or unexplained cardiomyopathy. Among the non-heart transplant cases, 54.7% of EMBs provided a clear diagnosis. The most common diagnosis was myocarditis (69%), followed by cardiac amyloidosis (CA) (26%). EMB was also helpful in detecting several rare cardiac conditions, such as eosinophilic granulomatosis with polyangiitis (EGPA), Fabry disease, and cardiac sarcoidosis. In a cohort of 101 patients who underwent both CMR and EMB, the results were concordant in 66% of cases. However, in 24.7% of patients, EMB was able to identify pathological conditions where CMR results were inconclusive, highlighting its complementary role in determining an accurate diagnosis. No complications were reported in any of the 212 EMBs performed. With advances in cardiac imaging modalities, EMB is not routinely indicated for the diagnosis of cardiomyopathy. However, EMB is still an important tool for diagnosing specific cardiac diseases and could be crucial for confirming the diagnosis. EMB is generally safe if performed at experienced centers.

中文翻译：

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临床实践中的心内膜心肌活检：5 年单中心经验的诊断率和见解

心内膜心肌活检（EMB）是一种评估各种心脏疾病的诊断工具，例如心肌炎和心肌浸润性疾病。它也是检测心脏移植后同种异体移植排斥反应的金标准筛查技术。尽管心肌组织表征的无创成像方式取得了进步，但 EMB 对于某些情况的明确诊断和确定治疗仍然是必要的。在此，我们报告我们最近使用 EMB 的经验及其诊断率。我们回顾性审查了 2018 年 3 月至 2023 年 3 月在我们机构进行的 EMB。收集了临床数据，包括患者特征、EMB 的适应症和诊断率以及手术相关并发症。记录活检的组织病理学结果，并根据其与临床诊断和心脏磁共振成像（CMR）结果的匹配程度进行分类。回顾性分析了从 178 名连续患者中获得的总共 212 个 EMB，其中 42 个活检用于同种异体移植排斥监测（10 名患者），其余用于推定诊断急性心肌炎或不明原因心肌病。在非心脏移植病例中，54.7%的EMB给出了明确的诊断。最常见的诊断是心肌炎（69%），其次是心脏淀粉样变性（CA）（26%）。EMB 还有助于检测几种罕见的心脏疾病，例如嗜酸性肉芽肿性多血管炎 (EGPA)、法布里病和心脏结节病。在同时接受 CMR 和 EMB 的 101 名患者的队列中，66% 的病例结果一致。然而，在 24.7% 的患者中，EMB 能够识别出 CMR 结果不确定的病理状况，凸显了其在确定准确诊断方面的补充作用。进行的 212 例 EMB 中均未报告并发症。随着心脏成像技术的进步，EMB 不再常规用于诊断心肌病。然而，EMB 仍然是诊断特定心脏病的重要工具，并且对于确诊至关重要。如果在经验丰富的中心进行 EMB 通常是安全的。