“…16 Many studies have sought to evaluate non-invasive methods to diagnose or monitor acute rejection, but so far none has attained the sensitivity and specificity of endomyocardial biopsy. [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] At this time, endomyocardial biopsy remains the gold standard to diagnose acute rejection, and iatrogenic TI due to endomyocardial biopsy appears to be a prominent cause of severe symptomatic TI that requires replacement or repair in addition to other possible factors.…”