Question: When should a heart biopsy be considered in the evaluation of heart failure?
Answer: Well, a heart biopsy is not always part of the evaluation of heart failure. Specifically, we don't do it in people for whom we believe heart failure is related to blockages in the coronary arteries because it's not going to give us additional information.
The people who are more likely to receive biopsies are those for whom we are not sure of the diagnosis. For example, in some cases, a person might have heart failure as the result of the increasing amount of the iron in the blood, a condition known as hemochromatosis. And in those people, identifying that as a cause would be important because we have effective treatments.
Similarly, people may present with heart failure, and we don't have a diagnosis. They may have abnormal protein deposition known as amyloidosis. There might be an immune function abnormality known as sarcoidosis.
So, the basic tenant to do a biopsy would include those individuals in whom we have not a good explanation for their heart failure.