Endomyocardial Biopsy in the Diagnosis of Myocarditis

To the Editor: Dec et al. (April 4 issue)* cite two possible explanations for the apparent lack of correlation between the clinical and biopsy diagnosis of active myocarditis. The clinical course in the overwhelming majority of patients is characterized by left-sided or biventricular failure, yet an endomyocardial biopsy specimen is obtained from the right ventricle. It is conceivable that if the left ventricular myocardium were sampled, the clinicopathological correlation would improve. One could further speculate that right ventricular failure in patients with biventricular failure is secondary to left ventricular failure rather than direct right ventricular involvement by an inflammatory.