Which of the following is an indication for endomyocardial biopsy?

• A. Evaluate the potential for organ rejection for a cardiac transplant patient
• B. Screen for asymptomatic hyperlipidemia
• C. Assess peripheral neuropathy
• D. Screen for lung cancer

Answer: (A)

Endomyocardial biopsy is used to obtain myocardial tissue to look for evidence of rejection in a cardiac transplant patient. By sampling the heart muscle, clinicians can directly assess cellular rejection (infiltrates of immune cells with corresponding myocyte injury) and antibody-mediated rejection, which guides adjustments in immunosuppressive therapy. This makes it the go-to test for evaluating potential allograft rejection after a heart transplant.

The other options aren’t indications for this procedure because they don’t require direct tissue diagnosis of the heart. Hyperlipidemia screening, neuropathy assessment, and cancer screening are managed with noninvasive tests, imaging, or laboratory studies rather than biopsy of the heart.