Key Points
- To establish evidence-based clinical practice recommendations balancing procedural risks and diagnostic utility of endomyocardial biopsy across adult and pediatric cardiovascular diseases.
- A joint multidisciplinary writing group from the AHA, ACC, and ESC conducted a comprehensive review of published literature on cardiomyopathies, arrhythmias, and cardiac tumors.
- The committee formulated standardized recommendations categorized across 14 specific clinical presentation scenarios rather than established post-biopsy diagnoses.
- Guideline classifications of recommendations (Class I to III) and levels of evidence (Level A to C) were assigned to each clinical scenario.
- Endomyocardial biopsy received a Class I recommendation (Level B evidence) for unexplained new-onset heart failure of less than 2 weeks' duration with hemodynamic compromise, and for onset of 2 weeks to 3 months associated with ventricular arrhythmias or conduction block.
- The procedure was categorized as Class IIa or IIb in clinical settings such as suspected cardiac sarcoidosis, hypersensitivity myocarditis, and arrhythmogenic cardiomyopathy.
- Routine endomyocardial biopsy was designated Class III (not recommended) for uncomplicated chronic heart failure responding to standard therapy and for classic hypertrophic cardiomyopathy.
Structured PICO
PPopulationAdult and pediatric patients with cardiovascular disease presenting with clinical syndromes where endomyocardial biopsy is considered (14 clinical scenarios identified).
IInterventionEndomyocardial biopsy (EMB)
This joint scientific statement provides evidence-based recommendations for the use of endomyocardial biopsy across 14 specific clinical scenarios in cardiovascular disease.