Diagnostic use of the endomyocardial biopsy: a consensus statement

The Association for European Cardiovascular Pathology and the Society for Cardiovascular Pathology created a task force to write a consensus document on when and how endomyocardial biopsy is of help for clinicians in the diagnosis and treatment of patients with heart failure, arrhythmias, and cardiac masses. Endomyocardial biopsy is the gold standard for a definitive diagnosis in disease entities like myocarditis, cardiac allograft rejection, and infiltration/storage myocardial disorders. Use of molecular biology techniques is mandatory to obtain specific information on etiology and pathogenesis and should be carried out as an investigation complementary to histology and immunohistochemistry. Given the complexity of these investigations, endomyocardial biopsy should be performed in or in collaboration with cardiac pathology referral centers, where the whole armamentarium of pathological investigation is available, including molecular techniques. Optimal use of the endomyocardial biopsy requires clinicopathologic correlations.