Myocardial biopsies have been performed as early as 1956, initially via transthoracic needle, and in 1962 for the first time in a transvenous approach. A consensus statement of the American Heart Association, American College of Cardiology, and European Society of Cardiology endorsed the acquisition of biopsies in several clinical scenarios in which biopsy-guided diagnostics can identify a treatable specific cause. Hence, a Class I indication (Evidence Level B) was ascribed to cases with new onset of unexplained heart failure with hemodynamic compromise, heart failure with ventricular arrhythmia or conduction disease, and heart failure unresponsive to conventional treatment, respectively.¹ Eleven other clinical scenarios including the diagnostic workup of “stable” cardiomyopathies have been assigned Class IIa/IIb recommendations. It is important to note that this scientific statement has not been updated since 2007. Thus, the potential contribution of advanced molecular diagnostics of tissue samples in a precision medicine approach has not yet been considered.

Traditionally, endomyocardial biopsies (EMBs) have been obtained from the right ventricle (RV) via central venous access. While seemingly easier, this strategy appears counterintuitive because the clinical consequences of many relevant pathologies affect predominantly the left ventricle (LV), for example, in most cases of cardiomyopathy or myocarditis. For instance, in sarcoidosis, granulomas are less frequently located in the RV, which lowers the sensitivity of diagnosing this treatable condition. Indeed, …

早在1956年就已进行了心肌活检，最初是通过经胸针进行的，1962年首次采用经静脉的方法进行了。美国心脏协会，美国心脏病学会和欧洲心脏病学会的共识声明支持在几种临床情况下进行活检，在这些情况下，活检指导的诊断可以确定可治疗的特定原因。因此，I级适应症（证据等级B）分别归因于新发的原因不明的心力衰竭伴有血流动力学损害，心力衰竭伴有室性心律不齐或传导性疾病，以及对常规治疗无反应的心力衰竭。^1个已将其他11种临床情况（包括“稳定的”心肌病的诊断检查）指定为IIa / IIb类推荐。重要的是要注意，该科学声明自2007年以来就没有更新过。因此，尚未考虑在精密医学方法中对组织样本进行先进的分子诊断的潜在作用。

传统上，已通过中央静脉通路从右心室（RV）获得了心内膜活检标本（EMB）。尽管看似更容易，但此策略似乎违反直觉，因为许多相关病理的临床后果主要影响左心室（LV），例如在大多数心肌病或心肌炎的情况下。例如，在结节病中，肉芽肿较少位于RV中，这降低了诊断这种可治疗状况的敏感性。确实， …