This Article Free upon publication Full Text Full Text (PDF) All Versions of this Article: 116/19/2216    most recent CIRCULATIONAHA.107.186093v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Cooper, L. T. Search for Related Content PubMed PubMed Citation Articles by Cooper, L. T. Related Collections Other heart failure Myocardial cardiomyopathy disease Transplantation AHA Statements and Guidelines CV surgery: transplantation, ventricular assistance, cardiomyopathy

(Circulation. 2007;116:2216-2233.)
© 2007 American Heart Association, Inc.

AHA/ACCF/ESC Scientific Statement

The Role of Endomyocardial Biopsy in the Management of Cardiovascular Disease

A Scientific Statement From the American Heart Association, the American College of Cardiology, and the European Society of Cardiology

Leslie T. Cooper, MD, FAHA, FACC; Kenneth L. Baughman, MD, FAHA, FACC; Arthur M. Feldman, MD, PhD, FAHA, FACC; Andrea Frustaci, MD; Mariell Jessup, MD, FAHA, FACC; Uwe Kuhl, MD; Glenn N. Levine, MD, FAHA, FACC; Jagat Narula, MD, PhD, FAHA; Randall C. Starling, MD, MPH; Jeffrey Towbin, MD, FAHA, FACC; Renu Virmani, MD, FACC, Endorsed by the Heart Failure Society of America and the Heart Failure Association of the European Society of Cardiology

Key Words: AHA Scientific Statements • biopsy • transplantation • heart failure • cardiomyopathy • myocarditis

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
The role of endomyocardial biopsy (EMB) in the diagnosis and treatment of adult and pediatric cardiovascular disease remains controversial, and the practice varies widely even among cardiovascular centers of excellence. A need for EMB exists because specific myocardial disorders that have unique prognoses and treatment are seldom diagnosed by noninvasive testing.¹ Informed clinical decision making that weighs the risks of EMB against the incremental diagnostic, prognostic, and therapeutic value of the procedure is especially challenging for nonspecialists because the relevant published literature is usually cited according to specific cardiac diseases, which are only diagnosed after EMB. To define the current role of EMB in the management of cardiovascular disease, a multidisciplinary group of experts in cardiomyopathies and cardiovascular pathology was convened by the American Heart Association (AHA), the American College of Cardiology (ACC), and the European Society of Cardiology (ESC). The present Writing Group was charged with reviewing the published literature on the role of EMB in cardiovascular diseases, summarizing this information, and making useful recommendations for clinical practice with classifications of recommendations and levels of evidence.

The Writing Group identified 14 clinical scenarios in which the incremental diagnostic, prognostic, and therapeutic value of EMB could be estimated and compared with the procedural risks. The recommendations contained in the present joint Scientific Statement are derived from a comprehensive review of the published literature on specific cardiomyopathies, arrhythmias, and cardiac tumors and are categorized according to presenting clinical syndrome rather than pathologically confirmed disease. The ultimate intent of this document is . . . [Full Text of this Article]

This article has been cited by other articles:

				L. T. Cooper The heat is off: immunosuppression for myocarditis revisited Eur. Heart J., August 2, 2009; 30(16): 1936 - 1939. [Full Text] [PDF]

				J. R. Kapoor, S. Szabo, T. Oikonomopoulos, H. M. Hoffmeister, H. Ammar, R. Fouda, and L. T. Cooper Jr. Myocarditis N. Engl. J. Med., July 23, 2009; 361(4): 422 - 424. [Full Text] [PDF]

				P Elliott and E Arbustini The role of endomyocardial biopsy in the management of cardiovascular disease: a commentary on joint AHA/ACC/ESC guidelines Heart, May 1, 2009; 95(9): 759 - 760. [Full Text] [PDF]

				S. A. Hunt, W. T. Abraham, M. H. Chin, A. M. Feldman, G. S. Francis, T. G. Ganiats, M. Jessup, M. A. Konstam, D. M. Mancini, K. Michl, et al. 2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation J. Am. Coll. Cardiol., April 14, 2009; 53(15): e1 - e90. [Full Text] [PDF]

				M. Jessup, W. T. Abraham, D. E. Casey, A. M. Feldman, G. S. Francis, T. G. Ganiats, M. A. Konstam, D. M. Mancini, P. S. Rahko, M. A. Silver, et al. 2009 Focused Update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines Developed in Collaboration With the International Society for Heart and Lung Transplantation J. Am. Coll. Cardiol., April 14, 2009; 53(15): 1343 - 1382. [Full Text] [PDF]

				2009 WRITING GROUP TO REVIEW NEW EVIDENCE AND UPDA, M. Jessup, W. T. Abraham, D. E. Casey, A. M. Feldman, G. S. Francis, T. G. Ganiats, M. A. Konstam, D. M. Mancini, P. S. Rahko, et al. 2009 Focused Update: ACCF/AHA Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: Developed in Collaboration With the International Society for Heart and Lung Transplantation Circulation, April 14, 2009; 119(14): 1977 - 2016. [Full Text] [PDF]

				2005 WRITING COMMITTEE MEMBERS, S. A. Hunt, W. T. Abraham, M. H. Chin, A. M. Feldman, G. S. Francis, T. G. Ganiats, M. Jessup, M. A. Konstam, D. M. Mancini, et al. 2009 Focused Update Incorporated Into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: Developed in Collaboration With the International Society for Heart and Lung Transplantation Circulation, April 14, 2009; 119(14): e391 - e479. [Full Text] [PDF]

				L. T. Cooper Jr. Myocarditis N. Engl. J. Med., April 9, 2009; 360(15): 1526 - 1538. [Full Text] [PDF]

				A. L.P. Caforio, F. Tona, A. Vinci, F. Calabrese, A. Ramondo, L. Cacciavillani, F. Corbetti, L. Leoni, G. Thiene, S. Iliceto, et al. Acute biopsy-proven lymphocytic myocarditis mimicking Takotsubo cardiomyopathy Eur J Heart Fail, April 1, 2009; 11(4): 428 - 431. [Abstract] [Full Text] [PDF]

				S. J. Matkovich, D. J. Van Booven, K. A. Youker, G. Torre-Amione, A. Diwan, W. H. Eschenbacher, L. E. Dorn, M. A. Watson, K. B. Margulies, and G. W. Dorn II Reciprocal Regulation of Myocardial microRNAs and Messenger RNA in Human Cardiomyopathy and Reversal of the microRNA Signature by Biomechanical Support Circulation, March 10, 2009; 119(9): 1263 - 1271. [Abstract] [Full Text] [PDF]

				S. Heymans, E. Hirsch, S. D. Anker, P. Aukrust, J.-L. Balligand, J. W. Cohen-Tervaert, H. Drexler, G. Filippatos, S. B. Felix, L. Gullestad, et al. Inflammation as a therapeutic target in heart failure? A scientific statement from the Translational Research Committee of the Heart Failure Association of the European Society of Cardiology Eur J Heart Fail, February 1, 2009; 11(2): 119 - 129. [Abstract] [Full Text] [PDF]

				W.H. W. Tang and G. S. Francis The Year in Heart Failure J. Am. Coll. Cardiol., November 11, 2008; 52(20): 1671 - 1678. [Full Text] [PDF]

				C. Basso, F. Ronco, F. Marcus, A. Abudureheman, S. Rizzo, A. C. Frigo, B. Bauce, F. Maddalena, A. Nava, D. Corrado, et al. Quantitative assessment of endomyocardial biopsy in arrhythmogenic right ventricular cardiomyopathy/dysplasia: an in vitro validation of diagnostic criteria Eur. Heart J., November 2, 2008; 29(22): 2760 - 2771. [Abstract] [Full Text] [PDF]

				L. T. Cooper Jr Right from the heart: when should myocardial biopsy be performed for suspected arrhythmogenic right ventricular cardiomyopathy/dysplasia? Eur. Heart J., November 2, 2008; 29(22): 2705 - 2707. [Full Text] [PDF]

				M. Jerosch-Herold, D. C. Sheridan, J. D. Kushner, D. Nauman, D. Burgess, D. Dutton, R. Alharethi, D. Li, and R. E. Hershberger Cardiac magnetic resonance imaging of myocardial contrast uptake and blood flow in patients affected with idiopathic or familial dilated cardiomyopathy Am J Physiol Heart Circ Physiol, September 1, 2008; 295(3): H1234 - H1242. [Abstract] [Full Text] [PDF]

				I. Kindermann, M. Kindermann, R. Kandolf, K. Klingel, B. Bultmann, T. Muller, A. Lindinger, and M. Bohm Predictors of Outcome in Patients With Suspected Myocarditis Circulation, August 5, 2008; 118(6): 639 - 648. [Abstract] [Full Text] [PDF]

				B. Heidecker, E. K. Kasper, I. S. Wittstein, H. C. Champion, E. Breton, S. D. Russell, M. M. Kittleson, K. L. Baughman, and J. M. Hare Transcriptomic Biomarkers for Individual Risk Assessment in New-Onset Heart Failure Circulation, July 15, 2008; 118(3): 238 - 246. [Abstract] [Full Text] [PDF]