New guidelines hope to clarify the role of endomyocardial biopsies
October 28, 2007 By Benjamin A. Olenchock, M.D. Ph.D. 
A new joint statement from the American Heart Association, American College of Cardiology and the European Society of Cardiology hopes to clarify the role of endomyocardial biopsy (EMB) in guiding treatment, in diagnosis, and in informing prognosis of cardiovascular diseases. There is significant controversy regarding the optimal use of EMB, and clinical practice varies greatly among large academic centers. The purpose of this joint statement was to gather and classify the current evidence for EMB in various diseases and provide a consensus recommendation, agreed upon by impartial governing bodies.
Ken Baughman, co-author of the joint recommendations, explained to wikidoc that “tissue is the issue… There’s no area of cardiology less clear than the issue of when to biopsy a patient. One center will biopsy a given patient while another center won’t. Our hope is that this statement will help to guide cardiologists about when to refer a patient for biopsy”.
Because there are no randomized controlled trials of EMB, the recommendations rely heavily upon expert opinion, case series, and registry data. The statement discusses 14 different scenarios in which EMB should or should not be considered. Most of the recommendations were Class II, meaning that there is divergence of opinion about the usefulness or efficacy of EMB in the clinical scenario. One issue that was generally agreed upon was that EMB has an important but very limited role in the evaluation of heart diseases. There were two scenarios, however, for which the authors gave EMB a Class I recommendation: (1) new-onset heart failure of <2 weeks duration associated with hemodynamic compromise and (2) new-onset heart failure of 2 weeks to 3-months duration associated with a dilated left ventricle, second or third-degree heart block, or failure to respond to usual care.
The recommendations end with a final note regarding the clinical utility of EMB as a research tool. Biopsies serve an essential role as source of tissue for investigational work, and the authors are hopeful that future work will use biopsy tissue for nucleotide-based methods of diagnosis and as tools to develop heart failure treatments.
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