Anzini Marco, Moretti Michele, Merlo Marco, Perkan Andrea, Bussani Rossana, Sinagra Gianfranco
Dipartimento Cardiovascolare, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Trieste, Italy.
G Ital Cardiol (Rome). 2013 Jul-Aug;14(7-8):504-16. doi: 10.1714/1308.14459.
Although the cause of myocarditis often remains unknown, a large variety of infections, systemic diseases, drugs and toxins have been associated with this disease. In most cases, myocarditis is induced by cardiotropic viruses and often evolves silently without discernible prognostic impact. However, in some patients, the lack of complete viral clearance and/or the association of a heart-specific inflammation can cause persistent myocyte damage, ultimately leading to progressive myocardial dilation and dysfunction or life-threatening arrhythmias. Spontaneous improvement of left ventricular function is described for 40-50% of patients. The diagnostic work-up and prognostic assessment of myocarditis should be multiparametric and all available resources should be employed, i.e. biomarkers of myocardial damage and ventricular dysfunction (troponin I, brain natriuretic peptide), advanced echocardiography, cardiac magnetic resonance and, in selected cases, endomyocardial biopsy (with histopathologic, immunohistochemical and virological analyses). These are the necessary prerequisites for an evidence-based and personalized management of myocarditis, which may require in some cases specific immunoactive treatments. However, controversial issues regarding diagnosis (such as role and timing of cardiac magnetic resonance imaging, role of endomyocardial biopsy) and therapy of myocarditis still remain unsolved. The purpose of this review is to analyze these crucial features in order to provide useful instructions for clinical practice.
尽管心肌炎的病因常常不明，但多种感染、全身性疾病、药物及毒素都与该病相关。在大多数情况下，心肌炎由嗜心肌病毒诱发，且通常悄然进展，对预后无明显影响。然而，在一些患者中，病毒未能完全清除和/或存在心脏特异性炎症可导致心肌持续损伤，最终引发进行性心肌扩张和功能障碍或危及生命的心律失常。40% - 50%的患者左心室功能可自发改善。心肌炎的诊断检查和预后评估应采用多参数方法，利用所有可用资源，即心肌损伤和心室功能障碍的生物标志物（肌钙蛋白I、脑钠肽）、先进的超声心动图、心脏磁共振成像，以及在特定情况下进行心内膜心肌活检（包括组织病理学、免疫组织化学和病毒学分析）。这些是基于循证和个体化管理心肌炎的必要前提，在某些情况下可能需要特定的免疫活性治疗。然而，关于心肌炎诊断（如心脏磁共振成像的作用和时机、心内膜心肌活检的作用）和治疗的争议性问题仍未解决。本综述的目的是分析这些关键特征，为临床实践提供有用指导。
