Navigating the Spectrum of Inflammatory Myocardial and Pericardial Syndromes: A Contemporary Approach to Diagnosis and Management

Dor Lotan; Daniel Oren; Yoo Jin Kim; Leslie T Cooper; Antonio Abbate; Massimo Imazio; Maria Salgado Guerrero; Jordan Lindekens; Rebecca Turner; Michael Garshick; Allan Klein; Taryn Youngstein; Nir Uriel; Brittany Weber; Luigi Adamo

doi:10.1016/j.cardfail.2026.03.008

Navigating the Spectrum of Inflammatory Myocardial and Pericardial Syndromes: A Contemporary Approach to Diagnosis and Management

J Card Fail. 2026 May;32(5):916-931. doi: 10.1016/j.cardfail.2026.03.008.

Authors

Affiliations

¹ Center for Pericardial Diseases, Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY, USA. Electronic address: Dl3491@cumc.columbia.edu.
² Center for Pericardial Diseases, Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY, USA.
³ Division of Cardiology, Duke University Hospital, Durham, NC, USA.
⁴ Department of Cardiovascular Medicine, Jacksonville, FL, USA.
⁵ Berne Cardiovascular Research Center, University of Virginia, Charlottesville, VA, USA.
⁶ Department of Medicine, University of Udine, and Cardiothoracic Department, University Hospital Santa Maria della Misericordia, ASUFC, Udine, Italy.
⁷ Division of Rheumatology, Department of Medicine, Columbia University Irving Medical Center, New York-Presbyterian Hospital, New York, NY, USA.
⁸ Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
⁹ Leon H. Charney Division of Cardiology, NYU Grossman School of Medicine, NYU Langone Health, New York, New York, USA.
¹⁰ Center for the Diagnosis and Treatment of Pericardial Diseases, Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Heart, Vascular and Thoracic Institute, Cleveland, OH, USA.
¹¹ National Heart and Lung Institute, Imperial College London and Department of Rheumatology, Imperial College Healthcare NHS Trust and Cleveland Clinic London, UK.
¹² Cardio-Rheumatology and Cardio-Dermatology Program, Division of Cardiology, Department of Internal Medicine and Dermatology, University of Texas Southwestern Medical Center, Dallas, TX, USA. Electronic address: Brittany.weber@utsouthwestern.edu.
¹³ Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: Ladamo2@jhmi.edu.

PMID: 42128584
DOI: 10.1016/j.cardfail.2026.03.008

Abstract

Inflammatory myocardial and pericardial syndromes (IMPS), including myocarditis, pericarditis, and overlapping myopericardial syndromes, constitute a heterogeneous group of immune-mediated cardiac disorders with clinical trajectories ranging from complete recovery to progressive heart failure and sudden death. This state-of-the-art review synthesizes current insights into immunopathogenesis, emphasizing the interplay among genetic susceptibility, environmental factors, and systemic inflammatory drivers, including rheumatological diseases. A pragmatic diagnostic framework is presented; it integrates targeted serological evaluation, genetic testing, multimodality imaging, and selective endomyocardial biopsy to enable precise etiologic classification. Therapeutic strategies are examined across the spectrum of disease severity, including guideline-directed medical therapy for heart failure, immunosuppression for autoimmune and fulminant phenotypes, and cytokine-directed biologics for recurrent pericarditis. Prognostic determinants, indications for advanced heart failure therapies, and emerging directions in precision immunology, molecular profiling, and AI-enabled risk stratification are discussed to guide future clinical and translational advances.

Keywords: Myocarditis; cardio-rheumatology; inflammatory heart disease; pericarditis.

Publication types

Review

MeSH terms

Disease Management*
Humans
Myocarditis* / diagnosis
Myocarditis* / therapy
Pericarditis* / diagnosis
Pericarditis* / therapy
Syndrome