Table 2

Comparing advantages and limitations of EMB vs fluid-based assays in CV diseases

  • Detailed information on cardiac tissue architecture, including myocardial cell death, scars, fibrosis, disarrays, cardiomyocyte changes, pathological vascular conditions, granulomas and inflammatory cell differentiation

  • Possibility of histological and molecular analysis

  • Clinical validation

  • Conclusive diagnosis of causative reasons for many CV diseases, eg, myocarditis and dilated cardiomyopathy

  • Evaluation of heart transplant

  • Sample size inadequacy and biopsy artefacts

  • Interpretative mistakes on behalf of pathologists

  • Limited to focal biopsy area at one point time (mainly limited to RV)

  • Failure to reflect tissue heterogeneity

  • Invasive and costly technique

  • Associated with pain and risk for patients

  • Difficult to repeat (not ideal for monitoring disease and response to drugs over time)

  • Failure to reflect tissue heterogeneity

Fluid-based assays
  • Isolation of intact cells and many biological molecules from many biological fluids

  • Mirror of cardiac tissue heterogeneity and dynamics

  • Sources of non-invasive biomarkers

  • Less expensive, quick and easily repeatable tests

  • Minimal pain/risk

  • Potential early diagnosis

  • Potential real-time monitoring of CV disease progression and individual drug response

  • Lack of standardised protocols

  • Management of small amounts and easily degradable materials after harvesting

  • Need to extremely sensitive and accurate tests

  • Absence of clinical validation

  • CV, cardiovascular; EMB, endomyocardial biopsy; RV, right ventricle.