Is immunosuppressive treatment an option for myocarditis?

Although relatively uncommon among cardiac diseases, myocarditis may often have significant sequelea, including heart failure and death. The development of a murine model and the use of myocardial biopsy and Dallas criteria have broadened our understanding of myocarditis and its manifestations. Regrettably, little can still be done to alter the natural course of the disease. The results of the Myocarditis Treatment Trial do not support routine treatment with immunosuppressive drugs for all patients with myocarditis, however the study did not incorporate methods of viral (DNA or RNA) identification or immunohistochemical techniques. Specific viral myocarditis diagnosis, by polymerase chain reaction or in situ hybridization, together with immunohistochemical markers, may help classify patients according to acute or chronic myocarditis and by etiology, and possibly identify subgroups of patients who would be most likely to benefit from immunosuppression. Some important questions regarding therapy for myocarditis may be answered by the ongoing European Study of the Epidemiology and Treatment of Cardiac Inflammatory Disease, while others still await double-blind controlled confirmation. In the interim, therapy is being directed towards the management of symptoms and complications, using conventional medical regimens for heart failure.