Viccaro Vincenzo, Valotta Amabile, Checcoli Elena, Landi Susanna, Cattaneo Fabio, Milzi Andrea, Duchini Mattia, Viani Giacomo Maria, Caretta Alessandro, Schlossbauer Susanne, Landi Antonio, Leo Laura Anna, Treglia Giorgio, Pedrazzini Giovanni, Valgimigli Marco, Pavon Anna Giulia
Department of Cardiology, Cardiocentro Ticino Institute, Ente Ospedaliero Cantonale, 6900 Lugano, Switzerland.
Faculty of Biomedical Sciences, Università Della Svizzera Italiana, 6900 Lugano, Switzerland.
J Cardiovasc Dev Dis. 2025 Aug 21;12(8):320. doi: 10.3390/jcdd12080320.
Eosinophilic myocarditis (EM) is a rare and potentially fatal form of acute myocarditis. Currently, no validated diagnostic criteria exist, and definitive diagnosis relies on endomyocardial biopsy (EMB) not devoid of periprocedural complications. This review aims to explore how a multimodality imaging approach can support early diagnosis, reduce reliance on EMB, enable risk stratification and monitor the response to anti-inflammatory therapy. In particular, while echocardiography provides rapid and useful information in suspected EM, cardiac magnetic resonance (CMR) remains the non-invasive gold standard for diagnosis due to its ability to provide accurate tissue characterization. Moreover, positron emission tomography/computed tomography (PET/CT) and cardiac CT (CCT) may offer valuable insights, particularly when echocardiographic image quality is poor or CMR is contraindicated or unavailable. Based on our experience and current literature, an optimal multimodality imaging approach should reserve EMB only for high-risk or inconclusive cases. Furthermore, this strategy offers complementary information, supporting clinical decisions and optimizing long-term outcomes.
嗜酸性粒细胞性心肌炎（EM）是一种罕见且可能致命的急性心肌炎形式。目前，尚无经过验证的诊断标准，确诊依赖于心内膜心肌活检（EMB），而该检查并非没有围手术期并发症。本综述旨在探讨多模态成像方法如何支持早期诊断、减少对EMB的依赖、实现风险分层并监测抗炎治疗的反应。特别是，虽然超声心动图在疑似EM时能提供快速且有用的信息，但心脏磁共振成像（CMR）因其能够提供准确的组织特征，仍然是诊断的非侵入性金标准。此外，正电子发射断层扫描/计算机断层扫描（PET/CT）和心脏CT（CCT）可能提供有价值的见解，尤其是当超声心动图图像质量较差或CMR禁忌或无法进行时。根据我们的经验和当前文献，最佳的多模态成像方法应仅将EMB保留用于高危或不确定的病例。此外，该策略提供补充信息，支持临床决策并优化长期预后。
