Yield of endomyocardial biopsy in patients with biventricular failure. Comparison of patients with normal vs reduced left ventricular ejection fraction.

Twenty five patients with biventricular failure underwent endomyocardial biopsy procedures. Twelve of these 25 patients had normal left ventricular ejection fraction. Endomyocardial biopsy sampling was useful in eight of 12 patients (67 percent) with biventricular failure and normal left ventricular ejection fraction. Biopsy specimens in five of these 12 patients demonstrated endocardial or infiltrative heart disease and excluded these diseases in three other patients with constrictive pericarditis. This study suggests that the clinical presentation of biventricular failure, combined with the noninvasive determination of a normal left ventricular ejection fraction, is helpful in selecting patients for endomyocardial biopsy study. Patients with biventricular failure and normal left ventricular ejection fractions have a high probability of having pericardial or infiltrative heart disease, conditions that often can be differentiated only by analysis of myocardial tissue. Hemodynamic assessment of patients without infiltrative processes further allows one to eliminate those patients with a high likelihood of having constrictive pericardial disease.