Endomyocardial Biopsy and Clinical Outcomes in Acute Myocarditis - Multicenter Cohort Study
- Journal
- Circulation journal : official journal of the Japanese Circulation Society (Q1)
- Published
- 10 September 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Junho Hyun, Kyung-Hee Kim, Minjung Bak, Hyukjin Park, In-Cheol Kim, Mi-Na Kim, et al.
- PMID
- 42716775
- DOI
- 10.1253/circj.CJ-26-0349
Why clinicians should know about it
- Picked for Pathology and Forensic Medicine (paper of the day, 11 September 2026): Multicenter cohort on endomyocardial biopsy outcomes
Abstract
BACKGROUND: Endomyocardial biopsy (EMB) remains the gold standard for diagnosing acute myocarditis (AM); however, its prognostic value has not been fully established. We investigated the prognostic impact of EMB, with a focus on fulminant myocarditis (FM). METHODS AND RESULTS: We included 841 AM patients across 7 hospitals who were categorized having undergone EMB (n=268) or not (n=573). The primary outcome was in-hospital death; the secondary outcome was a composite of all-cause death, cardiac transplantation, or left ventricular assist device implantation. In-hospital mortality was lower in the EMB group (6.3% vs. 11.5%; P=0.019), with a similar reduction in the EMB group among patients with FM (11.3% vs. 23.7%; P=0.002), despite a higher rate of extracorporeal membrane oxygenation. During a median follow-up of 447 days, the composite outcome was also lower in the EMB group among patients with FM (P=0.031). In multivariable analyses, EMB was independently associated with lower in-hospital mortality in both the overall cohort and the FM subgroup. Outcomes did not differ substantially across histopathologic subtypes, although patients with giant cell myocarditis had a worse prognosis. CONCLUSIONS: In patients with AM, EMB was associated with lower in-hospital mortality and improved long-term outcomes, particularly among those with FM. Further well-designed prospective studies are warranted to evaluate the clinical impact of EMB and its potential role in improving outcomes.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.