Recent years have seen the increase in global, multi-society consensus driven Guidelines and Position Papers. These initiatives are a particularly important mechanism to provide a practical and broadly credible approach to common problems which have defied common description, and to uncommon scenarios where a large heterogeneity of clinical practice occurs even in highly specialized, tertiary care settings. The recently published Universal Definition of Heart Failure is a prime example of the former condition 1 Bozkurt B Coats AJ Tsutsui H et al. Universal Definition and Classification of Heart Failure: A Report of the Heart Failure Society of America, Heart Failure Association of the European Society of Cardiology, Japanese Heart Failure Society and Writing Committee of the Universal Definition of Heart Failure. , while the Position Statement of Endomyocardial Biopsy (EMB) published in this issue of the Journal is a corresponding example of the latter 2

Seferović PM, Tsutsui H, McNamara DM, et al. HFA/HFSA/JHFS Position Statement on Endomyocardial Biopsy. Journal of Cardiac Failure. DOI: 10.1016/j.cardfail.2021.04.010.

. Below, we discuss the evolution of EMB from a single indication test, its subsequent expansion and, more recently, refinements of indication, performance and clinical value.