Diagnosing myocarditis in endomyocardial biopsies: survey of current practice

Gaspari, Monica De; Larsen, Brandon T.; d’Amati, Giulia; Kreutz, Kasey; Basso, Cristina; Michaud, Katarzyna; Halushka, Marc K.; Lin, Chieh‐Yu

doi:10.1016/j.carpath.2022.107494

Cited by 7 publications

(3 citation statements)

References 19 publications

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“…Histologic criteria of myocarditis, termed Dallas criteria , consist of the triad of myocardial immune infiltration, nonischemic myocyte death, and immune cells adjacent to dead myocytes . The European Society of Cardiology criteria for myocarditis are based on the presence of at least 14/mm 2 CD45 + inflammatory cells, including at least 7/mm 2 CD3 + T cells, on EMB . The immune cells typically consist of lymphocytes and macrophages.…”

Section: Methodsmentioning

confidence: 99%

Diagnosis and Treatment of Acute Myocarditis

Ammirati

Moslehi

2023

JAMA

132

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ImportanceAcute myocarditis, defined as a sudden inflammatory injury to the myocardium, affects approximately 4 to 14 people per 100 000 each year globally and is associated with a mortality rate of approximately 1% to 7%.ObservationsThe most common causes of myocarditis are viruses, such as influenza and coronavirus; systemic autoimmune disorders, such as systemic lupus erythematosus; drugs, such as immune checkpoint inhibitors; and vaccines, including smallpox and mRNA COVID-19 vaccines. Approximately 82% to 95% of adult patients with acute myocarditis present with chest pain, while 19% to 49% present with dyspnea, and 5% to 7% with syncope. The diagnosis of myocarditis can be suggested by presenting symptoms, elevated biomarkers such as troponins, electrocardiographic changes of ST segments, and echocardiographic wall motion abnormalities or wall thickening. Cardiac magnetic resonance imaging or endomyocardial biopsy are required for definitive diagnosis. Treatment depends on acuity, severity, clinical presentation, and etiology. Approximately 75% of patients admitted with myocarditis have an uncomplicated course, with a mortality rate of approximately 0%. In contrast, acute myocarditis that is complicated by acute heart failure or ventricular arrhythmias is associated with a 12% rate of either in-hospital mortality or need for heart transplant. Approximately 2% to 9% of patients have hemodynamic instability, characterized by inability to maintain adequate end-organ perfusion, and require inotropic agents, or mechanical circulatory devices, such as extracorporeal life support, to facilitate functional recovery. These patients have an approximately 28% rate of mortality or heart transplant at 60 days. Immunosuppression (eg, corticosteroids) is appropriate for patients who have myocarditis characterized by eosinophilic or giant cell myocardial infiltrations or due to systemic autoimmune disorders. However, the specific immune cells that should be targeted to improve outcomes in patients with myocarditis remain unclear.Conclusions and RelevanceAcute myocarditis affects approximately 4 to 14 per 100 000 people per year. First-line therapy depends on acuity, severity, clinical presentation, and etiology and includes supportive care. While corticosteroids are often used for specific forms of myocarditis (eg, eosinophilic or giant cell infiltrations), this practice is based on anecdotal evidence, and randomized clinical trials of optimal therapeutic interventions for acute myocarditis are needed.

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Section: Methodsmentioning

confidence: 99%

Diagnosis and Treatment of Acute Myocarditis

Ammirati

Moslehi

2023

JAMA

132

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“…However, attempts to establish clear cutoff points for inflammatory cellular infiltration and precise criteria for IHC use were based on relatively limited data [ 8 ]. Given the contentious nature of several pathological aspects of myocarditis, as highlighted by recent research, further studies are warranted to address these controversies and refine diagnostic criteria [ 9 , 10 ].…”

Section: Introduction: Myocarditis Hard To Suspect and Tricky To Diag...mentioning

confidence: 99%

The Role of the Immune System in Pathobiology and Therapy of Myocarditis: A Review

Vicenzetto,

Giordani,

Menghi

et al. 2024

Biomedicines

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The role of the immune system in myocarditis onset and progression involves a range of complex cellular and molecular pathways. Both innate and adaptive immunity contribute to myocarditis pathogenesis, regardless of its infectious or non-infectious nature and across different histological and clinical subtypes. The heterogeneity of myocarditis etiologies and molecular effectors is one of the determinants of its clinical variability, manifesting as a spectrum of disease phenotype and progression. This spectrum ranges from a fulminant presentation with spontaneous recovery to a slowly progressing, refractory heart failure with ventricular dysfunction, to arrhythmic storm and sudden cardiac death. In this review, we first examine the updated definition and classification of myocarditis at clinical, biomolecular and histopathological levels. We then discuss recent insights on the role of specific immune cell populations in myocarditis pathogenesis, with particular emphasis on established or potential therapeutic applications. Besides the well-known immunosuppressive agents, whose efficacy has been already demonstrated in human clinical trials, we discuss the immunomodulatory effects of other drugs commonly used in clinical practice for myocarditis management. The immunological complexity of myocarditis, while presenting a challenge to simplistic understanding, also represents an opportunity for the development of different therapeutic approaches with promising results.

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“…ECG signs, such as all varieties of "idiopathic" atrial or ventricular tachyarrhythmias or bradyarrhythmias, P-Q segment depression, and/or repolarization abnormalities, are likewise neither specific nor sensitive for myocarditis [11][12] . The established histological, immunological, and immunohistochemical results in cardiac tissue samples acquired during endomyocardial biopsy (EMB) provide the final diagnosis [13][14] .…”

Section: Introductionmentioning

confidence: 99%

Clinical Presentation of Myocarditis in Children Visiting Dr Ruth KM PFAU, Civil Hospital, Karachi. A Cross-Sectional Study

Ahmed¹,

Raza²,

Yahya³

et al. 2022

PJMHS

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Objective: To determine the frequency of various clinical presentations of myocarditis in children visiting to Dr Ruth KM PFAU, Civil Hospital Karachi. Study design: Cross-Sectional Study. Place and duration: Department of Pediatric Medicine, Dr Ruth K.M PFAU Civil Hospital, Karachi, Pakistan from September, 2020, to March, 2021 Methodology: The study covered all patients who visited Karachi's Civil Hospital and met the inclusion criteria. After describing the study's process, hazards, and benefits, informed consent was obtained. The initial ECG, echocardiography, and cardiac enzyme readings were all documented. Stroke, congenital heart disease, sepsis, asthma, pulmonary embolism, cardiomyopathy, gastroenteritis, diabetes mellitus, and renal failure were among the clinical presentations that were noted. The proforma that is supplied at the end was filled out with all the acquired data and used electronically for research. Results: Age was 6.8± 2.1 years on average. A total of 238 (67.6%) of the 352 patients were male, and 114 (32.4%) were female. In patients with myocarditis who presented clinically, renal disease was found in 46 (13.1%), cardiomyopathy in 30, congenital heart disease in 56 (15.9%), stroke in 41 (11.5%), gastroenteritis in 65 (18.5%), diabetes mellitus in 19 (5.4%), sepsis in 32 (9.2%), and asthma in 48 (13.6%) patients, while pulmonary embolism was found in 15 (4.3%) patients. Practical implication There is growing evidence to support the use of tests such as cardiac magnetic resonance imaging and serum N-terminal B-type natriuretic peptide measurements as supplements to clinical diagnosis. These could eventually lessen the need for invasive procedures like endomyocardial biopsy, which is still the gold standard. Conclusion: The most frequent clinical manifestation of myocarditis was gastroenteritis, which was followed by congenital heart disease and asthma. For the purpose of validating the results so far, additional extensive research is advised. Keywords: Clinical Presentation, Myocarditis, Epidemiology, Asthma, Gastroenteritis

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Diagnosing myocarditis in endomyocardial biopsies: survey of current practice

Cited by 7 publications

References 19 publications

Diagnosis and Treatment of Acute Myocarditis

Diagnosis and Treatment of Acute Myocarditis

The Role of the Immune System in Pathobiology and Therapy of Myocarditis: A Review

Clinical Presentation of Myocarditis in Children Visiting Dr Ruth KM PFAU, Civil Hospital, Karachi. A Cross-Sectional Study

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