Management of Acute Myocarditis and Chronic Inflammatory Cardiomyopathy

作者：Enrico Ammirati, Maria Frigerio, ERIC D. ADLER, Cristina Basso, David H. Birnie, Michela Brambatti, Matthias G. Friedrich, Karin Klingel, Jukka Y. A. Lehtonen, Javid J. Moslehi, Patrizia Pedrotti, Ornella E. Rimoldi, Heinz‐Peter Schultheiß, Carsten Tschöpe, Leslie T. Cooper, Paolo Guido Camici · 发表于：Circulation Heart Failure · 年份：2020 · DOI：10.1161/circheartfailure.120.007405 · 被引用次数：809 · 研究领域：Viral Infections and Immunology Research、Cardiovascular Effects of Exercise、Pericarditis and Cardiac Tamponade

Myocarditis is an inflammatory disease of the heart that may occur because of infections, immune system activation, or exposure to drugs. The diagnosis of myocarditis has changed due to the introduction of cardiac magnetic resonance imaging. We present an expert consensus document aimed to summarize the common terminology related to myocarditis meanwhile highlighting some areas of controversies and uncertainties and the unmet clinical needs. In fact, controversies persist regarding mechanisms that determine the transition from the initial trigger to myocardial inflammation and from acute myocardial damage to chronic ventricular dysfunction. It is still uncertain which viruses (besides enteroviruses) cause direct tissue damage, act as triggers for immune-mediated damage, or both. Regarding terminology, myocarditis can be characterized according to etiology, phase, and severity of the disease, predominant symptoms, and pathological findings. Clinically, acute myocarditis (AM) implies a short time elapsed from the onset of symptoms and diagnosis (generally <1 month). In contrast, chronic inflammatory cardiomyopathy indicates myocardial inflammation with established dilated cardiomyopathy or hypokinetic nondilated phenotype, which in the advanced stages evolves into fibrosis without detectable inflammation. Suggested diagnostic and treatment recommendations for AM and chronic inflammatory cardiomyopathy are mainly based on expert opinion given the lack of well-designed contempora...