Myocarditis implies the presence of diffuse or focal inflammation in the heart muscle. Although inflammation of the myocardium can be induced by a wide variety of different aetiologies, the most common cause is infectious agents; these are mostly viral, but can also include bacterial and protozoal microbes.
Inflammatory cardiomyopathy (ICM) refers to a broad group of disorders for which myocardial inflammation is associated with impaired function of the cardiac muscle. This term is rather unspecific since as in several cardiomyopathies a low degree of inflammation is present and an infectious agent can seldom be identified. Still, no monogenetic diseases have been found, although a genetic predisposition towards cardiotropic viruses and/or autoimmune reactions may occur in certain individuals. Rare causes of specific ICMs include giant cell myocarditis, cardiac sarcoidosis, and eosinophilic myocarditis. ICM can also occur in connection with autoimmune inflammatory diseases.
Clinical manifestation of myocarditis/ICM ranges from virtually asymptomatic course to severe fulminant heart failure accompanied by malignant arrhythmias. Still, fulminant myocarditis, a rare, sudden, and severe cardiac inflammation, is one of the main causes of cardiogenic shock in young adults. Prompt diagnosis and specific treatment strategies are needed to reduce mortality and the need for heart transplantation in these patients. Because of this heterogeneity in clinical presentation, and the infrequent use of endomyocardial biopsy, cardiac imaging has gradually acquired a key role in the non-invasive detection of myocardial inflammation, the assessment of etiology, and the management of specific therapies. Therapy is based on standard heart failure treatment; immunosuppressive or antimicrobial treatment may be considered in some cases depending on the results of the endomyocardial biopsy.
Many questions remain unanswered regarding the pathogenesis of myocarditis/ICM as well as the role of viral infections, genetic background, immune system, and the environment in disease progression and prognosis.
This article collection aims to:
1) Discuss the available evidence and identify the gaps in our understanding of the pathogenesis, diagnosis, and treatment of myocarditis and ICM.
2) Assess the role of different non-invasive imaging techniques in the exploration of myocardial inflammation.
3) Outline the role of inflammatory and immune cell markers, antibodies, and microRNAs for the diagnosis, guidance of therapeutic decisions and management in patients with myocarditis and inflammatory cardiomyopathy.
Myocarditis implies the presence of diffuse or focal inflammation in the heart muscle. Although inflammation of the myocardium can be induced by a wide variety of different aetiologies, the most common cause is infectious agents; these are mostly viral, but can also include bacterial and protozoal microbes.
Inflammatory cardiomyopathy (ICM) refers to a broad group of disorders for which myocardial inflammation is associated with impaired function of the cardiac muscle. This term is rather unspecific since as in several cardiomyopathies a low degree of inflammation is present and an infectious agent can seldom be identified. Still, no monogenetic diseases have been found, although a genetic predisposition towards cardiotropic viruses and/or autoimmune reactions may occur in certain individuals. Rare causes of specific ICMs include giant cell myocarditis, cardiac sarcoidosis, and eosinophilic myocarditis. ICM can also occur in connection with autoimmune inflammatory diseases.
Clinical manifestation of myocarditis/ICM ranges from virtually asymptomatic course to severe fulminant heart failure accompanied by malignant arrhythmias. Still, fulminant myocarditis, a rare, sudden, and severe cardiac inflammation, is one of the main causes of cardiogenic shock in young adults. Prompt diagnosis and specific treatment strategies are needed to reduce mortality and the need for heart transplantation in these patients. Because of this heterogeneity in clinical presentation, and the infrequent use of endomyocardial biopsy, cardiac imaging has gradually acquired a key role in the non-invasive detection of myocardial inflammation, the assessment of etiology, and the management of specific therapies. Therapy is based on standard heart failure treatment; immunosuppressive or antimicrobial treatment may be considered in some cases depending on the results of the endomyocardial biopsy.
Many questions remain unanswered regarding the pathogenesis of myocarditis/ICM as well as the role of viral infections, genetic background, immune system, and the environment in disease progression and prognosis.
This article collection aims to:
1) Discuss the available evidence and identify the gaps in our understanding of the pathogenesis, diagnosis, and treatment of myocarditis and ICM.
2) Assess the role of different non-invasive imaging techniques in the exploration of myocardial inflammation.
3) Outline the role of inflammatory and immune cell markers, antibodies, and microRNAs for the diagnosis, guidance of therapeutic decisions and management in patients with myocarditis and inflammatory cardiomyopathy.