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

摘要

May we draw your attention to the ESC/ AHA/ACC scientific statement published in the December issue of the European Heart Journal? Scenario 10 discusses the indication for endomyocardial biopsy in patients with suspected myocardial siderosis (due to hereditary or acquired haemochromatosis). This states that 'cardiac involvement in haemochromatosis usually can be diagnosed on the basis of history, clinical examination, and echocardiography or cardiac magnetic resonance (CMR) demonstrating dilated cardio-myopathy in the setting of laboratory abnormalities such as elevated serum iron and haemochromatosis gene mutation'. On the contrary, cardiac siderosis often presents late, and ventricular dimensions may be normal until the late stages of disease.2 In addition, conventional markers for iron overload such as serum ferritin and liver iron have been shown to bear no relation to myocardial iron deposition in the commonest form of acquired myocardial siderosis, beta-thalassaemia major.3 However, if access to CMR is indeed available, a robust, simple and quick measurement of myocardial T2* (acquired during a single 10-s breath hold scan on modern scanners) can provide an accurate assessment of myocardial iron load.4 Furthermore, this measurement has been cross-validated across scanners from each of the major manufacturers, making this technique readily accessible.5