Inflammatory Cardiomyopathy and Biopsies

Myocarditis is a cardiac inflammatory disease mainly caused by autoimmune processes and/or viral infections ( Fig 1) . Despite the advances of non-invasive diagnostic tests, endomyocardial biopsies (EMBs) remains the gold standard diagnostic technique for myocarditis and inflammatory cardiomyopathy. If the immune response fails to eliminate the infectious agent or inflammatory process does not resolve, only EMB can elucidate the cause and the status of the disease. Such tissue analyses are the prerequisite for an initiation of a specific antiviral or an anti-inflammatory treatment in addition to basic heart failure therapy. Other conditions such as giant cell myocarditis or cardiac sarcoidosis benefit from an anti-inflammatory treatment during the acute phase, so EMB has an important role both in acute and chronic settings. There are  promising results with immunosuppressive or antiviral therapy in specific clinical scenarios according to published data (Fig 2) (German Research Program)

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Fig 1 Pathogenesis 1
(Fig 1 Pathogenesis)

Fig 2 Biopsy guided treatment options in Myocarditis
(Fig 2 Biopsy guided treatment options in Myocarditis)
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