title: The role of invasive diagnostics and its impact on the treatment of dilated cardiomyopathy: A systematic review.
abstract: BACKGROUND
  Dilated cardiomyopathy is one of the most frequent causes of non-ischemic heart failure. Many factors including genetic disorders, infectious agents, toxins, drugs and autoimmune disorders might take part in the development of dilated cardiomyopathy. Diagnosis of left ventricular dilatation is most often limited to performing echocardiography and excluding ischemic etiology (coronary angiography). Since many pathologies take place at the cellular and subcellular level the only way to clarify the etiology of the disease is to examine the myocardium itself (endomyocardial biopsy).
  
  
  METHODS
  A systematic literature search was conducted for studies published between September 2000 and September 2015 using the PubMed database.
  
  
  RESULTS
  Of 7104 studies identified, 73 studies were included in this review. Controversies raised by opponents of the endomyocardial biopsy collide with the low percentage of serious complications confirmed in several single-center registries. Based on the available data the overall complication rate varies from 1% to about 3%, with 0.5% risk of serious complications. According to the current recommendations of the European and American scientific societies endomyocardial biopsy should be performed in most cases of left ventricular dilatation and heart failure of non-ischemic etiology. Endomyocardial biopsy allows for making the diagnosis and providing prognostic information especially in patients with familial dilated cardiomyopathy, diabetic cardiomyopathy with dilated phenotype, alcoholic cardiomyopathy, peripartum cardiomyopathy, iron overload cardiomyopathy, as well as inflammatory and viral cardiomyopathy. Iron overload cardiomyopathy, peripartum cardiomyopathy, inflammatory and viral cardiomyopathy are potentially treatable and reversible.
  
  
  CONCLUSIONS
  Targeted therapies are more effective when started early before myocardial injury becomes irreversible. Unfortunately, non-invasive techniques are not precise enough to decide if and which targeted therapy is required. Therefore endomyocardial biopsy should be mainly recognized as the essential diagnostic tool and should not be postponed.
authors: Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland. Electronic address: katarzyna77.gil@gmail.com.
authors: Katarzyna E
authors: KE
authors: Gil
authors: Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland; Mossakowski Medical Research Centre, Academy of Science, Warsaw, Poland.
authors: Agnieszka
authors: A
authors: Pawlak
authors: Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland; Mossakowski Medical Research Centre, Academy of Science, Warsaw, Poland.
authors: Robert J
authors: RJ
authors: Gil
authors: Mossakowski Medical Research Centre, Academy of Science, Warsaw, Poland.
authors: Małgorzata
authors: M
authors: Frontczak-Baniewicz
authors: Department of Invasive Cardiology, Central Clinical Hospital of the Ministry of Interior, Warsaw, Poland.
authors: Jacek
authors: J
authors: Bil
mesh_terms: D001706:Biopsy; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis* / Q000473:pathology / Q000628:therapy*; D017023:Coronary Angiography; D018450:Disease Progression; D006801:Humans; D007249:Inflammation / Q000473:pathology; D009206:Myocardium / Q000473:pathology / Q000648:ultrastructure
keywords: Coronary angiography; Dilated cardiomyopathy; Endomyocardial biopsy; Heart failure treatment