Biopsy diagnosis of myocarditis.

In closing, we can only note that none of the classification schemes for myocarditis has been perfect for clinicians, pathologists, and researchers alike. The definition and classification protocol offered by the "Dallas" group is based solely on histology, but we urge its use by physicians and other researchers as a means of imposing some standardization on the study of myocarditis. The question of optimum treatment, particularly immunosuppressive therapy, has never been definitively answered, but it is now clear that a large, multicenter randomized trial is the only proper method to search for such an answer. Standard nomenclature is a prerequisite for this study. In the meantime, the clinical correlates and prognostic utility of these histologic categories may be defined; these morphologic groupings will probably be shown to be clinically heterogeneous. In the end, we hope a hybrid clinical-pathologic scheme for the diagnosis and classification of myocarditis will be forged. Such a protocol, ideally, will allow the correlation of structure with function and also reliably predict clinical behavior and response to treatment so that someday we may be able to both counsel and cure persons with myocarditis.