A 14-year-old girl underwent orthotopic heart transplantatio…
A 14-year-old girl underwent orthotopic heart transplantation 8 months ago for dilated cardiomyopathy. She presents to clinic with 1 week of fatigue, decreased exercise tolerance, and mild shortness of breath. Her vital signs are notable for a heart rate of 105 beats/min and blood pressure of 92/58 mmHg. Physical examination reveals a new gallop rhythm and mild hepatomegaly. Echocardiography demonstrates a decrease in left ventricular systolic function compared with her study from 3 months ago. Which of the following is the most appropriate next step to establish the diagnosis?
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