Evaluation of Postmortem Endomyocardial Biopsy Specimens From 38 Patients With Lymphocytic Myocarditis: Implications for Role of Sampling Error
Section snippets
Study Groups.
From the autopsy records at the Mayo Clinic for the 15 years between 1973 and 1987, 201 cases were identified in which myocarditis had been recorded as the sole or a contributory cause of death. Among these, 38 met the following criteria and were considered suitable for the current study: (1) the Dallas criteria6 were fulfilled for the diagnosis of myocarditis (Fig. 1), (2) the inflammatory infiltrate was predominantly lymphocytic, and (3) the gross cardiac specimen was available for review and
Study Groups.
For groups I and II, the ranges in age were similar (3 months to 86 years and 5 to 92 years, respectively), but the mean ages differed appreciably (35 and 51 years, respectively). Myocarditis affected male patients twice as frequently as female patients—7 (64%) in group I and 18 (67%) in group II were males.
Sudden death occurred in 91% of group I but in only 41% of group II. In group II, it occurred most frequently among patients with those disorders commonly known to be associated with sudden
DISCUSSION
In light of the results of the current investigation of the evaluation of myocarditis by endomyocardial biopsy, three areas warrant further comment: (1) the extent of sampling error, (2) the role of quantitation of inflammatory cells, and (3) the limitations of the current study.
ACKNOWLEDGMENT
We thank Duane M. Ilstrup, M.S., Section of Biostatistics, for assistance with the statistical analysis of the data.
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2022, Clinical Microbiology and InfectionCitation Excerpt :Other limitations of the Dallas criteria include significant interobserver variability and sampling errors [66,67]. Although less of an issue in autopsy-derived tissue, the focal nature of the disease leads to sampling errors that have been shown to compromise the sensitivity of the histopathological diagnosis of myocarditis by EMB [68,69]. Chow et al. had estimated that a mean of 17 samples per patient would be required to establish a diagnosis of myocarditis [69], which likely explains why examining an increased number of cardiac tissue blocks at the time of autopsy resulted in a greater likelihood of identifying focal myocarditis.
Presented in part at the International Symposium on Inflammatory Heart Disease, Snowmass, Colorado, July 28, 1988.
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Current address: Loma Linda University Medical Center, Loma Linda, California.
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Current address: Baylor College of Medicine, Houston, Texas.