Diagnosis and treatment of myocarditis and inflammatory cardiomyopathy. Consensus document of the SEC-Working Group on Myocarditis
Rev Esp Cardiol (Engl Ed). 2024 May 17:S1885-5857(24)00156-7.
doi: 10.1016/j.rec.2024.02.022.
Online ahead of print.
[Article in
English,
Spanish]
Authors
Fernando Domínguez
1
, Aitor Uribarri
2
, José María Larrañaga-Moreira
3
, Luis Ruiz-Guerrero
4
, Pablo Pastor-Pueyo
5
, Jara Gayán-Ordás
5
, Beatriz Fernández-González
6
, Alberto Esteban-Fernández
7
, Manuel Barreiro
8
, Silvia López-Fernández
9
, Federico Gutiérrez-Larraya Aguado
10
, Domingo Pascual-Figal
11
; Working Group on Myocarditis of the Spanish Society of Cardiology
Affiliations
- 1 Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain. Electronic address: fdominguezrodriguez@gmail.com.
- 2 Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
- 3 Servicio de Cardiología, Complejo Hospitalario A Coruña, A Coruña, Spain.
- 4 Servicio de Cardiología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain.
- 5 Servicio de Cardiología, Hospital Universitario Arnau de Vilanova, Lleida, Spain.
- 6 Servicio de Cardiología, Hospital Universitario de Burgos, Burgos, Spain.
- 7 Servicio de Cardiología, Hospital Universitario Severo Ochoa, Leganés, Madrid, Spain.
- 8 Servicio de Cardiología, Hospital Álvaro Cunqueiro, Vigo, Pontevedra, Spain.
- 9 Servicio de Cardiología, Hospital Universitario Virgen de las Nieves, Granada, Spain.
- 10 Servicio de Cardiología, Hospital Universitario La Paz, Madrid, Spain.
- 11 Servicio de Cardiología, Hospital Universitario Virgen de la Arrixaca, Universidad de Murcia, El Palmar, Murcia, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain. Electronic address: dpascual@um.es.
Abstract
Myocarditis is defined as myocardial inflammation and its etiology is highly diverse, including infectious agents, drugs, and autoimmune diseases. The clinical presentation also varies widely, extending beyond the classic clinical picture of acute chest pain, and includes cases of cardiomyopathy of unknown cause whose etiology may be inflammatory. Because certain patients may benefit from targeted treatments, the search for the etiology should begin when myocarditis is first suspected. There remain several areas of uncertainty in the diagnosis and treatment of this disease. Consequently, this consensus document aims to provide clear recommendations for its diagnosis and treatment. Hence, a diagnostic algorithm is proposed, specifying when non-invasive diagnosis with cardiac MR is appropriate vs a noninvasive approach with endomyocardial biopsy. In addition, more novel aspects are discussed, such as when to suspect an underlying genetic etiology. The recommendations cover the management of myocarditis and inflammatory cardiomyopathy, both for general complications and specific clinical entities.
Keywords:
Biopsia endomiocárdica; Cardiac magnetic resonance; Cardiorresonancia magnética; Endomyocardial biopsy; Inflammatory cardiomyopathy; Miocardiopatía inflamatoria; Miocarditis; Myocarditis.
Copyright © 2024 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.