Role of Left Ventricular Biopsy in the Management of Heart Disease

Abstract

More than 50 years after the first description of transvenous endomyocardial heart biopsy (EMB),1 the role of EMB remains controversial. EMB is often essential for the diagnosis of allograft rejection and specific forms of native myocardial disease, including amyloidosis and giant cell myocarditis,2 yet expert consensus for the utility of EMB in more common scenarios is lacking. For example, a 2013 position statement from the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases recommends heart biopsy be performed for all cases of suspected myocarditis, including most acute and chronic dilated cardiomyopathy.3 In contrast, the “2013 ACCF/AHA Guideline for the Management of Heart Failure” recommends that “endomyocardial biopsy should not be performed in the routine evaluation of patients with heart failure.” (class of recommendation III).4 The European Society of Cardiology Working Group and the American College of Cardiology Foundation/American Heart Association recommendations are both based on expert opinion (level of evidence C). Article see p 1531 Most authorities in the field agree on the unique ability of EMB to diagnose specific viral heart infections and distinguish prognostically valuable histological patterns such as sarcoidosis or lymphocytic myocarditis.5,6 Lymphocytic myocarditis is a histological biomarker that predicts both successful bridging to recovery after left ventricular (LV) assist device placement in adults7 …