Lasica Ratko, Djukanovic Lazar, Savic Lidija, Krljanac Gordana, Zdravkovic Marija, Ristic Marko, Lasica Andjelka, Asanin Milika, Ristic Arsen
Department of Cardiology, Emergency Center, University Clinical Center of Serbia, 11000 Belgrade, Serbia.
Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
Diagnostics (Basel). 2023 Sep 28;13(19):3073. doi: 10.3390/diagnostics13193073.
Although the frequency of myocarditis in the general population is very difficult to accurately determine due to the large number of asymptomatic cases, the incidence of this disease is increasing significantly due to better defined criteria for diagnosis and the development of modern diagnostic methods. The multitude of different etiological factors, the diversity of the clinical picture, and the variability of the diagnostic findings make this disease often demanding both for the selection of the diagnostic modality and for the proper therapeutic approach. The previously known most common viral etiology of this disease is today overshadowed by new findings based on immune-mediated processes, associated with diseases that in their natural course can lead to myocardial involvement, as well as the iatrogenic cause of myocarditis, which is due to use of immune checkpoint inhibitors in the treatment of cancer patients. Suspecting that a patient with polymorphic and non-specific clinical signs and symptoms, such as changes in ECG and echocardiography readings, has myocarditis is the starting point in the diagnostic algorithm. Cardio magnetic resonance imaging is non-invasive and is the gold standard for diagnosis and clinical follow-up of these patients. Endomyocardial biopsy as an invasive method is the diagnostic choice in life-threatening cases with suspicion of fulminant myocarditis where the diagnosis has not yet established or there is no adequate response to the applied therapeutic regimen. The treatment of myocarditis is increasingly demanding and includes conservative methods of treating heart failure, immunomodulatory and immunospressive therapy, methods of mechanical circulatory support, and heart transplantation. The goal of developing new diagnostic and therapeutic methods is to reduce mortality from this complex disease, which is still high.
尽管由于大量无症状病例的存在，普通人群中心肌炎的发病率很难准确确定，但由于诊断标准的进一步明确和现代诊断方法的发展，这种疾病的发病率正在显著上升。多种不同的病因、临床表现的多样性以及诊断结果的变异性，使得这种疾病在诊断方式的选择和适当治疗方法的确定上都颇具挑战。以前已知的这种疾病最常见的病毒病因，如今已被基于免疫介导过程的新发现所掩盖，这些发现与在其自然病程中可导致心肌受累的疾病以及心肌炎的医源性病因有关，后者是由于在癌症患者治疗中使用免疫检查点抑制剂所致。怀疑一名具有多形性和非特异性临床体征及症状（如心电图和超声心动图读数变化）的患者患有心肌炎，是诊断算法的起点。心脏磁共振成像具有非侵入性，是这些患者诊断和临床随访的金标准。心内膜心肌活检作为一种侵入性方法，是怀疑暴发性心肌炎且诊断尚未确立或对应用的治疗方案无充分反应的危及生命病例的诊断选择。心肌炎的治疗要求越来越高，包括治疗心力衰竭的保守方法、免疫调节和免疫抑制疗法、机械循环支持方法以及心脏移植。开发新的诊断和治疗方法的目标是降低这种复杂疾病的死亡率，目前该疾病的死亡率仍然很高。
