Heart Failure Association of the ESC, Heart Failure Society of America and Japanese Heart Failure Society Position statement on endomyocardial biopsy

Petar M Seferović; Hiroyuki Tsutsui; Dennis M McNamara; Arsen D Ristić; Cristina Basso; Biykem Bozkurt; Leslie T Cooper Jr; Gerasimos Filippatos; Tomomi Ide; Takayuki Inomata; Karin Klingel; Aleš Linhart; Alexander R Lyon; Mandeep R Mehra; Marija Polovina; Ivan Milinković; Kazufumi Nakamura; Stefan D Anker; Ivana Veljić; Tomohito Ohtani; Takahiro Okumura; Thomas Thum; Carsten Tschöpe; Giuseppe Rosano; Andrew J S Coats; Randall C Starling

doi:10.1002/ejhf.2190

Heart Failure Association of the ESC, Heart Failure Society of America and Japanese Heart Failure Society Position statement on endomyocardial biopsy

Eur J Heart Fail. 2021 Jun;23(6):854-871. doi: 10.1002/ejhf.2190. Epub 2021 May 19.

Authors

Petar M Seferović¹, Hiroyuki Tsutsui², Dennis M McNamara³, Arsen D Ristić^{4

5}, Cristina Basso⁶, Biykem Bozkurt⁷, Leslie T Cooper Jr⁸, Gerasimos Filippatos⁹, Tomomi Ide², Takayuki Inomata¹⁰, Karin Klingel¹¹, Aleš Linhart¹², Alexander R Lyon¹³, Mandeep R Mehra¹⁴, Marija Polovina^{4

5}, Ivan Milinković^{4

5}, Kazufumi Nakamura¹⁵, Stefan D Anker¹⁶, Ivana Veljić⁴, Tomohito Ohtani¹⁷, Takahiro Okumura¹⁸, Thomas Thum^{19

20}, Carsten Tschöpe²¹, Giuseppe Rosano^{22

23}, Andrew J S Coats^{24

25}, Randall C Starling²⁶

Affiliations

¹ Serbian Academy of Sciences and Arts, Belgrade, Serbia.
² Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.
³ Heart and Vascur Institute, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
⁴ Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia.
⁵ Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
⁶ Cardiovascular Pathology Unit, Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua, Padua, Italy.
⁷ Winters Center for Heart Failure, Cardiovascular Research Institute, Baylor College of Medicine, Michael E. DeBakey VA Medical Center, Houston, TX, USA.
⁸ Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, USA.
⁹ Attikon University Hospital, Department of Cardiology, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece.
¹⁰ Department of Cardiovascular Medicine, Kitasato University Kitasato Institute Hospital, Tokyo, Japan.
¹¹ Cardiopathology, Institute for Pathology, University Hospital, Tuebingen, Germany.
¹² Department of Cardiovascular Medicine, Charles University, Prague, Czech Republic.
¹³ National Heart and Lung Institute, Imperial College and Royal Brompton Hospital, London, UK.
¹⁴ Heart and Vascular Center, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
¹⁵ Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
¹⁶ Department of Cardiology (CVK); and Berlin Institute of Health Center for Regenerative Therapies (BCRT), German Centre for Cardiovascular Research (DZHK) partner site Berlin; Charité Universitätsmedizin, Berlin, Germany.
¹⁷ Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
¹⁸ Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
¹⁹ Institute of Molecular and Translational Therapeutic Strategies, Hannover Medical School, Hannover, Germany.
²⁰ Fraunhofer Institute for Toxicology and Experimental Medicine, Hannover, Germany.
²¹ Berlin Institute of Health (BIH) and Berlin-Brandenburg Center for Regenerative Therapies (BCRT), Department of Cardiology, Campus Virchow Klinikum, Charite University, Berlin, Germany.
²² Department of Medical Sciences, IRCCS San Raffaele, Rome, Italy.
²³ Cardiology Clinical Academic Group, St George's Hospitals NHS Trust, London, UK.
²⁴ Monash University, Melbourne, Australia.
²⁵ University of Warwick, Coventry, UK.
²⁶ Cleveland Clinic, Cleveland, OH, USA.

PMID: 34010472
DOI: 10.1002/ejhf.2190

Abstract

Endomyocardial biopsy (EMB) is an invasive procedure, globally most often used for the monitoring of heart transplant (HTx) rejection. In addition, EMB can have an important complementary role to the clinical assessment in establishing the diagnosis of diverse cardiac disorders, including myocarditis, cardiomyopathies, drug-related cardiotoxicity, amyloidosis, other infiltrative and storage disorders, and cardiac tumours. Improvements in EMB equipment and the development of new techniques for the analysis of EMB samples have significantly improved diagnostic precision of EMB. The present document is the result of the Trilateral Cooperation Project between the Heart Failure Association of the European Society of Cardiology, the Heart Failure Society of America, and the Japanese Heart Failure Society. It represents an expert consensus aiming to provide a comprehensive, up-to-date perspective on EMB, with a focus on the following main issues: (i) an overview of the practical approach to EMB, (ii) an update on indications for EMB, (iii) a revised plan for HTx rejection surveillance, (iv) the impact of multimodality imaging on EMB, and (v) the current clinical practice in the worldwide use of EMB.

Keywords: Amyloidosis; Cardiac tumours; Cardiomyopathy; Cardiotoxicity; Endomyocardial biopsy; Heart failure; Heart transplantation; Myocarditis; Sarcoidosis.

MeSH terms

Biopsy
Endocardium
Heart Failure* / diagnosis
Heart Transplantation*
Humans
Japan
Myocardium