Endomyocardial Biopsy and Clinical Outcomes in Acute Myocarditis ― Multicenter Cohort Study ―

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.

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BibTeX RIS

BibTeX

@article{hyun2026endomyocardial,
  title = {{Endomyocardial Biopsy and Clinical Outcomes in Acute Myocarditis ― Multicenter Cohort Study ―}},
  author = {Junho Hyun and Kyung-Hee Kim and Minjung Bak and Hyukjin Park and In-Cheol Kim and Mi-Na Kim and Sang Eun Lee and Jeong Hoon Yang},
  journal = {Circulation Journal},
  year = {2026},
  month = oct,
  doi = {10.1253/circj.cj-26-0349},
  url = {https://www.jstage.jst.go.jp/article/circj/90/11/90_CJ-26-0349/_article},
  note = {CC BY-NC-ND},
}

RIS

TY  - JOUR
TI  - Endomyocardial Biopsy and Clinical Outcomes in Acute Myocarditis ― Multicenter Cohort Study ―
AU  - Junho Hyun
AU  - Kyung-Hee Kim
AU  - Minjung Bak
AU  - Hyukjin Park
AU  - In-Cheol Kim
AU  - Mi-Na Kim
AU  - Sang Eun Lee
AU  - Jeong Hoon Yang
PY  - 2026
DA  - 2026/10/23
JO  - Circulation Journal
DO  - 10.1253/circj.cj-26-0349
UR  - https://www.jstage.jst.go.jp/article/circj/90/11/90_CJ-26-0349/_article
AB  - 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.
SN  - 1347-4820
SN  - 1346-9843
ER  -

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