Endomyocardial biopsy was suggested for all patients with cardiac MRI scans that were positive for myocarditis and a reduced LVEF in accordance with the guidelines on myocardial biopsy. Biopsy specimens were evaluated by both histologie and polymerase chain reaction techniques. Eight endomyocardial specimens were obtained from the right side of the ventricular septum of each patient with a flexible bioptome (Westmed, St Ingbert, Germany) via the femoral vein approach. Four specimens were used for the histologie evaluation, and the other 4 specimens were subjected to DNA extraction for detection of streptococcal genomes