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Acta Cardiol. 2019 Jan 16:1-9. doi: 10.1080/00015385.2018.1561597. [Epub ahead of print]

Indications and diagnostic yield of endomyocardial biopsies for unexplained cardiomyopathy, a single center experience.

Author information

a Department of Cardiology , Ziekenhuis Oost-Limburg , Genk , Belgium.
b Department of Pathology , Ziekenhuis Oost-Limburg , Genk , Belgium.
c Biomedical Research Institute, Faculty of Medicine and Life Sciences , Hasselt University , Diepenbeek , Belgium.
d Doctoral School for Medicine and Life Sciences , Hasselt University , Diepenbeek , Belgium.



Endomyocardial biopsies (EMBs) remain the golden standard to diagnose underlying pathophysiologic process in heart failure (HF), when potential therapeutic decisions cannot be made by non-invasive techniques. However, changes in the field of non-invasive diagnostic testing might have an impact on the need for performing an EMB in certain scenarios.


We performed a retrospective analysis of consecutive EMBs performed in a single, non-academic, tertiary-care centre. EMBs were performed between February 2009 and March 2018. Baseline characteristics including non-invasive imaging and hemodynamic profile were assessed. Indications of EMBs were analysed in accordance with the 2007-AHA/ACC/ESC-scientific statement on EMBs.


A total of 57 patients (74% male) were included. The overall diagnostic yield was 58%, with a trend towards a higher yield in left-side (64%) versus right-side EMBs (45%; p = .346). The majority of patients (88%) underwent EMBs for a class IIa-recommendation, 9% for a class-I recommendation and the remaining patients for a class IIb-indication. Of the EMBs for a class IIa indication, 82% (n = 47) was for an unexplained restrictive cardiomyopathy, in which 53% (n = 25) revealed a diagnosis (of whom n = 23 patients had amyloidosis). Subtyping of the EMBs with a pathologic diagnosis of amyloidosis revealed that 52% (n = 12) had transthyretin amyloidosis (ATTR) and 43% (n = 10) had light-chain amyloidosis (AL). Overall one major (1.7%) and one minor (1.7%) complication occurred following the EMB-procedure.


When following the AHA/ACC/ESC-scientific statement on EMBs, the performance of EMBs had a high diagnostic yield, with acceptable complication rates. However, in patients presenting with an unexplained restricted cardiomyopathy, technetium-labelled bone scanning could offer a non-invasive approach to establishing the diagnosis of ATTR, mitigating the need for EMBs in a subset of patients.


Heart failure; amyloidosis; cardiovascular surgery; diagnostic yield; endomyocardial biopsy

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