Why is EMB sensitivity <100% in giant cell myocarditis?

GCM has patchy distribution with multinucleated giant cells and necrosis. Sampling error reduces sensitivity to 82-85%. Taking 5+ biopsies from RV septum increases sensitivity significantly.

What histological features diagnose GCM?

GCM: multinucleated giant cells on background of lymphocytic and eosinophilic infiltrate with myocyte necrosis. No granuloma formation (distinguishes from cardiac sarcoidosis). Eosinophilic infiltrate distinguishes from other myocarditis.

What is the prognosis of giant cell myocarditis?

Without treatment GCM has median survival 5.5 months from diagnosis. With immunosuppression (cyclosporine + prednisone + azathioprine), 5-year transplant-free survival reaches ~50%. Heart transplant is definitive therapy.

Giant Cell Myocarditis Biopsy Sensitivity

Estimate endomyocardial biopsy sensitivity for giant cell myocarditis (GCM). Sensitivity is 82-85% with sampling error due to patchy disease; multiple biopsies improve yield.

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