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Endomyocardial biopsy in this study of 1250 biopsied patients (mean of five samples/patient) proved to be a remarkably safe technique with no lethal complications. It may help to detect the underlying cause of heart failure but is handicapped by sampling error in focal disease processes (such as myocarditis and sarcoid heart disease) when conventional light and electron microscopy are used. In this biopsy series 123 patients (9.8%) suffered from severe heart failure; lymphocytic infiltrates were found in only 10 (8%). Immunohistological data suggested a secondary humoral immunopathogenesis in all patients with myocarditis and perimyocarditis, in 75% of patients with postmyocarditic heart muscle disease and in 48% of patients with primary dilated cardiomyopathy. There may thus be a need for a new classification of heart muscle diseases that includes immunological parameters of humoral and cellular autoreactivity. [ABSTRACT FROM PUBLISHER]

Twenty-seven patients with bronchopulmonary or generalised sarcoidosis were classified with a clinical score as certain, probable, possible or no cardiac sarcoidosis. Certain cardiac involvement was assumed only when endomyocardial biopsy or necropsy showed a granuloma of the heart (N = I); it was probable (N = 14) when a resting or an exercise-induced defect in the thallium scan was found and severe arrhythmia (Lown III-V), A–V block (2nd or 3rd degree), cardiomegaly, pericardial effusion or segmental wall motion abnormality was detected in addition; it was considered possible (N = 7) when only one of the above-mentioned criteria (rhythm disturbances, cardiomegaly/pericardial effusion, exercise-induced defect in the thallium scan) was positive.With thallium-201 scintigraphy a defect at rest was found in nine, on exercise in six, at rest and on exercise in six, and no defects were found in six cases. Determination of antimyocardial antibodies with adult human and rat cardiocytes and with cryostat sections, and of circulating immune complexes, showed differences from non-cardiac controls but not from patients with sarcoidosis and a negative score for cardiac manifestations. Antimyolemmal antibodies of the IgG class were found in all patients, and of the IgM class in 30–50% of all patients irrespective of cardiac involvement. Only complement fixation to the myolemma was cardiospecific. Cytolytic serum activity, NK cell activity, antibody-dependent (ADCC) and -independent lymphocytotoxicity against vital heart cells could not be detected in any group of patients. [ABSTRACT FROM PUBLISHER]