Contribution and Risks of Left Ventricular Endomyocardial Biopsy in Patients with Cardiomyopathies: A Retrospective Study over a 28-Year Period

E ndomyocardial biopsy (EMB) of the right ventricle (RV) and left ventricle (LV) was introduced into clinical practice in 1963 by Sekiguchi and Konno 1 and gradually became a recognized, valuable diagnostic investigation for primary myocardial diseases. Over the years, the development of new techniques such as immunohistochemistry, in situ hybridiza-tion, and polymerase chain reaction to detect a myocardial viral infection improved the diagnostic performance on EMB tissue. On the other hand, the development of new therapies for specific myocardial diseases, administrable on the basis of histological and molecular diagnosis, has given adjunctive value to the contribution of EMB. Despite the recognized diagnostic, prognostic, and therapeutic value of this procedure, recently described in a joint scientific statement, 2 the choice of the ventricular site of EMB is still a matter of question. Indeed, although EMB of the RV, approached by right internal jugular vein or femoral vein, is considered safe, the LV approach has not yet gained widespread acceptance because of concerns about possible more severe complications. Moreover, although the diagnostic advantage of a biventricular approach is widely recognized, 3 the diagnostic yield of LV versus RV biopsy is still unclear. In the present single-center study, we report the experience of our group in a large population of patients over a 28-year period, analyzing retrospectively the incidence of complications and the diagnostic advantages of LVEMB. noninvasive and invasive cardiac studies, including a diagnostic EMB, because of clinically suspected myocarditis or nonischemic cardiomyopathies. In particular, 2396 (56.8%) underwent a biven-tricular EMB, 1153 (27.3%) underwent a selective LVEMB, and 672 (15.9%) underwent a selective RVEMB. Thus, among the 4221 Background—Use of left ventricular (LV) endomyocardial biopsy (EMB) to investigate cardiomyopathies is currently discouraged because it is considered riskier than and as contributive as right ventricular (RV) biopsy. The aim of our study is to report our experience with this option and to discuss its advantages and disadvantages. underwent selective LVEMB, and 672 (15.9%) underwent selective RVEMB. The rate of complications and histological findings were retrospectively analyzed. The periprocedural major complication rate (perforation with or without cardiac tamponade, embolization) was 0.33% for LVEMB and 0.45% for RVEMB, with a significant decrease in the rate of major complications with time (from 1. for both), denoting a steep learning curve. No patients died. When the structural and functional abnormalities affected exclusively the LV, the diagnostic yield of LVEMB was 97.8% compared with 53% for RVEMB. …