Tymińska Agata, Ozierański Krzysztof, Skwarek Aleksandra, Kapłon-Cieślicka Agnieszka, Baritussio Anna, Grabowski Marcin, Marcolongo Renzo, Caforio Alida Lp
First Department of Cardiology, Medical University of Warsaw, 1a Banacha St., 02-097 Warsaw, Poland.
Division of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 2-35128 Padova, Italy.
J Pers Med. 2022 Jan 30;12(2):183. doi: 10.3390/jpm12020183.
Myocarditis is an inflammatory heart disease induced by infectious and non-infectious causes frequently triggering immune-mediated pathologic mechanisms leading to myocardial damage and dysfunction. In approximately half of the patients, acute myocarditis resolves spontaneously while in the remaining cases, it may evolve into serious complications including inflammatory cardiomyopathy, arrhythmias, death, or heart transplantation. Due to the large variability in clinical presentation, unpredictable course of the disease, and lack of established causative treatment, myocarditis represents a challenging diagnosis in modern cardiology. Moreover, an increase in the incidence of myocarditis and inflammatory cardiomyopathy has been observed in recent years. However, there is a growing potential of available non-invasive diagnostic methods (biomarkers, serum anti-heart autoantibodies (AHA), microRNAs, speckle tracking echocardiography, cardiac magnetic resonance T1 and T2 tissue mapping, positron emission tomography), which may refine the diagnostic workup and/or noninvasive follow-up. Personalized management should include the use of endomyocardial biopsy and AHA, which may allow the etiopathogenetic subsets of myocarditis (infectious, non-infectious, and/or immune-mediated) to be distinguished and implementation of disease-specific therapies. In this review, we summarize current knowledge on myocarditis and inflammatory cardiomyopathy, and outline some practical diagnostic, therapeutic, and follow-up algorithms to facilitate comprehensive individualized management of these patients.
心肌炎是一种由感染性和非感染性原因引起的炎症性心脏病，常引发免疫介导的病理机制，导致心肌损伤和功能障碍。大约一半的患者中，急性心肌炎可自发缓解，而在其余病例中，它可能演变成严重并发症，包括炎症性心肌病、心律失常、死亡或心脏移植。由于临床表现差异很大、疾病进程不可预测以及缺乏既定的病因治疗方法，心肌炎在现代心脏病学中是一个具有挑战性的诊断。此外，近年来观察到心肌炎和炎症性心肌病的发病率有所增加。然而，可用的非侵入性诊断方法（生物标志物、血清抗心脏自身抗体（AHA）、微小RNA、斑点追踪超声心动图、心脏磁共振T1和T2组织成像、正电子发射断层扫描）的潜力越来越大，这可能会完善诊断检查和/或非侵入性随访。个性化管理应包括使用心内膜心肌活检和AHA，这可能有助于区分心肌炎的病因发病学亚组（感染性、非感染性和/或免疫介导性）并实施针对疾病的治疗。在本综述中，我们总结了关于心肌炎和炎症性心肌病的当前知识，并概述了一些实用的诊断、治疗和随访算法，以促进对这些患者的全面个性化管理。
