Endomyocardial Biopsy and Clinical Outcomes in Acute Myocarditis ― Multicenter Cohort Study ―
Year: 2026
Type: article
Study design: Observational 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.
Source: Circulation Journal
Institutions: Asan Medical Center, University of Ulsan, Seoul National University, Seoul National University Bundang Hospital, Chonnam National University Hwasun Hospital, Keimyung University Dongsan Hospital, Keimyung University, Korea University Anam Hospital, Samsung Medical Center, Sungkyunkwan University
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7212034984