Potential of the right ventricular endomyocardial biopsy to diagnose and assist in the management of congestive heart failure: insights from recent clinical trials.

In the United States congestive heart failure is most commonly due to ischemic cardiomyopathy, but nonischemic causes of cardiomyopathy can also result in congestive heart failure. Indeed, nonischemic dilated cardiomyopathy affects approximately 100,000 persons in the United States and is responsible for 45% of heart transplants. Although these patients undergo thorough cardiovascular evaluation, a specific cause is usually not found. Endomyocardial biopsy may yield diagnostic and prognostic information in this setting, and there has been a renewed interest in the use of endomyocardial biopsy in the evaluation of specific subsets of patients with congestive heart failure to identify potentially treatable myocarditides. However, the role of endomyocardial biopsy in the evaluation of patients with nonischemic cardiomyopathy is ill defined. In this review, the authors discuss the latest data on the risks and the utility of endomyocardial biopsy in the management of heart failure in the setting of dilated cardiomyopathy and specific myocarditides. Gaps in present knowledge and the obstacles to research in this area are identified.