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European Heart Journal Advance Access originally published online on May 2, 2008
European Heart Journal 2008 29(13):1696; doi:10.1093/eurheartj/ehn189
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

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

Lisa Anderson

Department of Cardiology
St George's Hospital
London SW17 OQT
UK
Tel: +44 20 8675 1220
Fax: +44 20 8675 4505
Email: lisa.anderson{at}stgeorges.nhs.uk

Dudley Pennell

CMR Unit
Royal Brompton Hospital
Sydney Street
London SW3 6WP
UK

May we draw your attention to the ESC/AHA/ACC scientific statement published in the December issue of the European Heart Journal.1 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 cardiomyopathy 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

We would, therefore, propose that myocardial biopsy for assessment of iron overload should only be performed if access to CMR and measurement of T2* is not available or if aetiologies other than iron overload are being assessed.

References

  1. Cooper LT, Baughman KL, Feldman AM, Frustaci A, Jessup M, Kuhl U, Levine GN, Narula J, Starling RC, Towbin J, Virmani R. 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 Endorsed by the Heart Failure Society of America and the Heart Failure Association of the European Society of Cardiology. Eur Heart J (2007) 28:3076–3093.[Free Full Text]
  2. Henry WL, Nienhuis AQ, Wiener M, Miller DR, Canale VC, Piomelli S. Echocardiographic abnormalities in patients with transfusion-dependent anaemia and secondary myocardial iron deposition. Am J Med (1978) 64:547–555.[CrossRef][Web of Science][Medline]
  3. Anderson LJ, Holden S, Davis B, Prescott E, Charrier CC, Bunce NH, Firmin DN, Wonke B, Porter J, Walker JM, Pennell DJ. Cardiovascular T2* magnetic resonance for the early diagnosis of myocardial iron overload. Eur Heart J (2001) 22:2171–2179.[Abstract/Free Full Text]
  4. Tanner MA, He T, Westwood MA, Firmin DN, Pennell DJ. Thalassemia International Federation Heart T2* Investigators. Multi-center validation of the transferability of the magnetic resonance T2* technique for the quantification of tissue iron. Haematologica (2006) 91:1388–1391.[Abstract/Free Full Text]

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This Article
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
29/13/1696    most recent
ehn189v1
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