Skip to main content

Advertisement

SpringerLink
Log in

Myocarditis: A Clinical Overview

  • Myocardial Disease (A Abbate, Section Editor)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

In this paper we will review the modern diagnostic approach to patients with clinically suspected myocarditis as well as the treatment modalities and strategy in light of up-to-date clinical experience and scientific evidence.

Recent Findings

Rapidly expanding evidence suggests that myocardial inflammation is frequently underdiagnosed or overlooked in clinical practice, although new therapeutic options have been validated. Moreover, the available evidence suggests that subclinical cardiac involvement has negative prognostic impact on morbidity and mortality and should be actively investigated and adequately treated.

Summary

Myocarditis represents a growing challenge for physicians, due to increased referral of patients for endomyocardial biopsy (EMB) or cardiac magnetic resonance (CMR), and requires a highly integrated management by a team of caring physicians.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Abbreviations

AAV:

ANCA-associated vasculitis

AECVP:

Association of European Cardiovascular Pathology

AHA:

Anti-heart autoantibodies

AOSD:

Adult-onset still disease

CMR:

Cardiac magnetic resonance

DRESS:

Drug rash with eosinophilia and systemic symptoms

ECMO:

Extracorporeal membrane oxygenation

EMB:

Endomyocardial biopsy

ESC:

European Society of Cardiology

HHV6:

Human herpesvirus 6

LGE:

Late gadolinium enhancement

MACE:

Major cardiovascular events

NSAID:

Nonsteroidal anti-inflammatory drug

PVB19:

Parvovirus B19

SCVP:

Society for Cardiovascular Pathology

SID:

Systemic immune-mediated disease

SLE:

Systemic lupus erythematosus

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major Importance

  1. Aretz HT, Billingham ME, Edwards WD, et al. Myocarditis. a histopathologic definition and classification. Am J Cardiovasc Pathol. 1987;1:3–14.

    CAS  PubMed  Google Scholar 

  2. Caforio AL, Marcolongo R, Basso C, Iliceto S. Clinical presentation and diagnosis of myocarditis. Heart. 2015;101:1332–44.

    Article  CAS  PubMed  Google Scholar 

  3. Caforio AL, Calabrese F, Angelini A, et al. A prospective study of biopsy-proven myocarditis: prognostic relevance of clinical and aetiopathogenetic features at diagnosis. Eur Heart J. 2007;28:1326–33.

    Article  PubMed  Google Scholar 

  4. Angelini A, Crosato M, Boffa GM, et al. Active versus borderline myocarditis: clinicopathological correlates and prognostic implications. Heart. 2002;87:210–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Grün S, Schumm J, Greulich S, et al. Long-term follow-up of biopsy-proven viral myocarditis: predictors of mortality and incomplete recovery. J Am Coll Cardiol. 2012;59:1604–15.

    Article  PubMed  Google Scholar 

  6. Mahrholdt H, Goedecke C, Wagner A, et al. Cardiovascular magnetic resonance assessment of human myocarditis: a comparison to histology and molecular pathology. Circulation. 2004;109:1250–8.

    Article  PubMed  Google Scholar 

  7. Lurz P, Eitel I, Adam J, et al. Diagnostic performance of CMR imaging compared with EMB in patients with suspected myocarditis. JACC Cardiovasc Imag. 2012;5:513–24.

    Article  Google Scholar 

  8. Bohnen S, Radunski UK, Lund GK, et al. Performance of T1 and T2 mapping cardiovascular magnetic resonance to detect active myocarditis in patients with recent-onset heart failure. Circ Cardiovasc Imag. 2015;8:e003073.

    Article  Google Scholar 

  9. Francone M, Chimenti C, Galea N, et al. CMR sensitivity varies with clinical presentation and extent of cell necrosis in biopsy-proven acute myocarditis. JACC Cardiovasc Imag. 2014;7:254–63.

    Article  Google Scholar 

  10. de Cobelli JF, Pieroni M, Esposito A, et al. Delayed gadolinium-enhanced cardiac magnetic resonance in patients with chronic myocarditis presenting with heart failure or recurrent arrhythmias. Am Coll Cardiol. 2006;47:1649–54.

    Article  Google Scholar 

  11. Ison MG, Campbell V, Rembold C, Dent J, Hayden FG. Cardiac findings during uncomplicated acute influenza in ambulatory adults. Clin Infect Dis. 2005;40:415–22.

    Article  PubMed  Google Scholar 

  12. Greaves K, Oxford JS, Price CP, Clarke GH, Crake T. The prevalence of myocarditis and skeletal muscle injury during acute viral infection in adults: measurement of cardiac troponins I and T in 152 patients with acute influenza infection. Arch Intern Med. 2003;163:165–8.

    Article  PubMed  Google Scholar 

  13. Fabre A, Sheppard MN. Sudden adult death syndrome and other non-ischaemic causes of sudden cardiac death. Heart. 2006;92:316–20.

    Article  CAS  PubMed  Google Scholar 

  14. Rezkalla SH, Kloner RA. Influenza-related viral myocarditis. WMJ. 2010;109:209–13.

    PubMed  Google Scholar 

  15. Escher F, Kühl U, Gross U, et al. Aggravation of left ventricular dysfunction in patients with biopsy-proven cardiac human herpesvirus A and B infection. J Clin Virol. 2015;63:1–5.

    Article  CAS  PubMed  Google Scholar 

  16. Pauschinger M, Bowles NE, Fuentes-Garcia FJ, et al. Detection of adenoviral genome in the myocardium of adult patients with idiopathic left ventricular dysfunction. Circulation. 1999;99:1348–54.

    Article  CAS  PubMed  Google Scholar 

  17. Bowles NE, Ni J, Kearney DL, et al. Detection of viruses in myocardial tissues by polymerase chain reaction. evidence of adenovirus as a common cause of myocarditis in children and adults. J Am Coll Cardiol. 2003;42:466–72.

    Article  PubMed  Google Scholar 

  18. Kühl U, Pauschinger M, Bock T, et al. Parvovirus B19 infection mimicking acute myocardial infarction. Circulation. 2003;108:945–50.

    Article  PubMed  CAS  Google Scholar 

  19. Cheng MP, Kozoriz MG, Ahmadi AA, Kelsall J, Paquette K, Onrot JM. Post-vaccination myositis and myocarditis in a previously healthy male. Allergy, Asthma Clin Immunol. 2016;12:6.

    Article  CAS  Google Scholar 

  20. Figueredo VM. Chemical cardiomyopathies: the negative effects of medications and nonprescribed drugs on the heart. Am J Med. 2011;124:480–8.

    Article  CAS  PubMed  Google Scholar 

  21. Lumsden RH, Bloomfield GS. The causes of HIV-associated cardiomyopathy: a tale of two worlds. Biomed Res Int. 2016;2016:8196560.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  22. Zhang W, Lavine KJ, Epelman S, et al. Necrotic myocardial cells release damage-associated molecular patterns that provoke fibroblast activation in vitro and trigger myocardial inflammation and fibrosis in vivo. J Am Heart Assoc. 2015;4:e001993.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  23. Bybee KA, Prasad A. Stress-related cardiomyopathy syndromes. Circulation. 2008;118:397–409.

    Article  PubMed  Google Scholar 

  24. Campuzano O, Fernández-Falgueras A, Sarquella-Brugada G, et al. A genetically vulnerable myocardium may predispose to myocarditis. J Am Coll Cardiol. 2015;66:2913–4.

    Article  PubMed  Google Scholar 

  25. Rose NR, Neumann DA, Herskowitz A, Traystman MD, Beisel KW. Genetics of susceptibility to viral myocarditis in mice. Pathol Immunopathol Res. 1988;7:266–78.

    Article  CAS  PubMed  Google Scholar 

  26. Rose NR. Myocarditis: infection versus autoimmunity. J Clin Immunol. 2009;29:730–7.

    Article  CAS  PubMed  Google Scholar 

  27. Mankad R, Bonnichsen C, Mankad S. Hypereosinophilic syndrome: cardiac diagnosis and management. Heart. 2016;102:100–6.

    Article  CAS  PubMed  Google Scholar 

  28. •• Misra DP, Shenoy SN. Cardiac involvement in primary systemic vasculitis and potential drug therapies to reduce cardiovascular risk. Rheumatol Int. 2017;37:151–67. Excellent review on cardiac involvement in the setting of systemic vasculitis.

    Article  CAS  PubMed  Google Scholar 

  29. Birnie DH, Nery PB, Ha AC, Beanlands RS. Cardiac sarcoidosis. J Am Coll Cardiol. 2016;68:411–21.

    Article  PubMed  Google Scholar 

  30. Schwartz T, Diederichsen LP, Lundberg IE, Sjaastad I, Sanner H. Cardiac involvement in adult and juvenile idiopathic inflammatory myopathies. RMD Open. 2016;2:e000291.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Dieval C, Deligny C, Meyer A, et al. Myocarditis in patients with antisynthetase syndrome: prevalence, presentation, and outcomes. Medicine (Baltomore). 2015;94:e798.

    Article  CAS  Google Scholar 

  32. • Thomas G, Cohen Aubart F, Chiche L, et al. Lupus myocarditis: initial presentation and long-term outcomes in a multicentric series of 29 patients. J Rheumatol. 2017;44:24–32. Informative study on the high incidence of cardiac involvement in the setting of SLE.

    Article  PubMed  Google Scholar 

  33. • Johnson DB, Balko JM, Compton ML, et al. Fulminant myocarditis with combination immune checkpoint blockade. N Engl J Med. 2016;375:1749–55. Interesting paper reporting a clinical model of autoimmune opportunistic myocarditis triggered by oncological immunotherapy.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  34. Bourgeois GP, Cafardi JA, Groysman V, Hughey LC. A review of DRESS-associated myocarditis. J Am Acad Dermatol. 2012;66:e229–36.

    Article  PubMed  Google Scholar 

  35. Savage E, Wazir T, Drake M, Cuthbert R, Wright G. Fulminant myocarditis and macrophage activation syndrome secondary to adult-onset Still's disease successfully treated with tocilizumab. Rheumatology (Oxford). 2014;53:1352–3.

    Article  Google Scholar 

  36. Nagatomo Y, Tang WH. Autoantibodies and cardiovascular dysfunction: cause or consequence? Curr Heart Fail Rep. 2014;11:500–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Doti PI, Escoda O, Cesar-Díaz S, et al. Congenital heart block related to maternal autoantibodies: descriptive analysis of a series of 18 cases from a single center. Clin Rheumatol. 2016;35:351–6.

    Article  PubMed  Google Scholar 

  38. Baughman KL. Diagnosis of myocarditis: death of Dallas criteria. Circulation. 2006;113:593–5.

    Article  PubMed  Google Scholar 

  39. Leone O, Veinot JP, Angelini A, et al. 2011 consensus statement on endomyocardial biopsy from the Association for European Cardiovascular Pathology and the Society for Cardiovascular Pathology. Cardiovasc Pathol. 2012;21:245–74.

    Article  PubMed  Google Scholar 

  40. Wojnicz R, Nowalany-Kozielska E, Wodniecki J, et al. Immunohistological diagnosis of myocarditis. potential role of sarcolemmal induction of the MHC and ICAM-1 in the detection of autoimmune mediated myocyte injury. Eur Heart J. 1998;19:1564–72.

    Article  CAS  PubMed  Google Scholar 

  41. Schultz JC, Hilliard AA, Cooper Jr LT, Rihal CS. Diagnosis and treatment of viral myocarditis. Mayo Clin Proc. 2009;84:1001–9.

    Article  PubMed  PubMed Central  Google Scholar 

  42. McCarthy 3rd RE, Boehmer JP, Hruban RH, et al. Long-term outcome of fulminant myocarditis as compared with acute (nonfulminant) myocarditis. N Engl J Med. 2000;342:690–5.

    Article  PubMed  Google Scholar 

  43. Lauer B, Niederau C, Kühl U, et al. Cardiac troponin T in patients with clinically suspected myocarditis. J Am Coll Cardiol. 1997;30:1354–9.

    Article  CAS  PubMed  Google Scholar 

  44. Caforio AL, Goldman JH, Haven AJ, Baig KM, Libera LD, McKenna WJ. Circulating cardiac-specific autoantibodies as markers of autoimmunity in clinical and biopsy-proven myocarditis. The Myocarditis Treatment Trial Investigators. Eur Heart J. 1997;18:270–5.

    Article  CAS  PubMed  Google Scholar 

  45. •• Pinto YM, Elliott PM, Arbustini E, et al. Proposal for a revised definition of dilated cardiomyopathy and its implications for clinical practice: a position statement of the ESC Working Group on myocardial and pericardial diseases. Eur Heart J. 2016;37:1850–8. An expert consensus paper on diagnostic workup in dilated cardiomyopathy.

    Article  PubMed  Google Scholar 

  46. Felker GM, Boehmer JP, Hruban RH, et al. Echocardiographic findings in fulminant and acute myocarditis. J Am Coll Cardiol. 2000;36:227–32.

    Article  CAS  PubMed  Google Scholar 

  47. • Mohammed AG, Alghamdi AA, ALjahlan MA, Al-Homood IA. Echocardiographic findings in asymptomatic systemic lupus erythematosus patients. Clin Rheumatol. 2016. doi:10.1007/s10067-016-3486-4. Interesting paper exploring the screening role of echocardiography in SLE asymptomatic patients.

    Google Scholar 

  48. Agewall S, Beltrame JF, Reynolds HR, et al. ESC working group position paper on myocardial infarction with non-obstructive coronary arteries. Eur Heart J. 2017;38:143–53.

    PubMed  Google Scholar 

  49. Friedrich MG, Sechtem U, Schulz-Menger J, et al. Cardiovascular magnetic resonance in myocarditis: A JACC White Paper. J Am Coll Cardiol. 2009;53:1475–87.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Ferreira VM, Piechnik SK, Dall'Armellina E, et al. T(1) mapping for the diagnosis of acute myocarditis using CMR: comparison to T2-weighted and late gadolinium enhanced imaging. JACC Cardiovasc Imag. 2013;6:1048–58.

    Article  Google Scholar 

  51. Antonarakis ES, Wung PK, Durand DJ, Leyngold I, Meyerson DA. An atypical complication of atypical pneumonia. Am J Med. 2006;119:824–7.

    Article  PubMed  Google Scholar 

  52. •• Prasad M, Hermann J, Gabriel SE, et al. Cardiorheumatology: cardiac involvement in systemic rheumatic disease. Nat Rev Cardiol. 2015;12:168–76. A critical expert position paper on the cardiological work-up for patients affected by systemic immune-mediated diseases.

    Article  PubMed  Google Scholar 

  53. Baccouche H, Mahrholdt H, Meinhardt G, Merher R, Voehringer M, Hill S, et al. Diagnostic synergy of non-invasive cardiovascular magnetic resonance and invasive endomyocardial biopsy in troponin-positive patients without coronary artery disease. Eur Heart J. 2009;30:2869–79.

    Article  CAS  PubMed  Google Scholar 

  54. •• Sławek S, Araszkiewicz A, Gaczkowska A, et al. Endomyocardial biopsy via the femoral access - still safe and valuable diagnostic tool. BMC Cardiovasc Disord. 2016;16:222. A critical review on the safety and utility of EMB in myocarditis patients.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Cooper LT, Baughman KL, Feldman AM, et al. The role of endomyocardial biopsy in the management of cardiovascular disease: a scientific statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology. Circulation. 2007;116:2216–33.

    Article  PubMed  Google Scholar 

  56. Diagnostic standard and guidelines for sarcoidosis. Jpn J Sarcoidosis Granulomatous Disord 2007;27:89–102.

  57. Gilotra NA, Bennett MK, Shpigel A, et al. Outcomes and predictors of recovery in acute-onset cardiomyopathy: a single-center experience of patients undergoing endomyocardial biopsy for new heart failure. Am Heart J. 2016;179:116–26.

    Article  PubMed  Google Scholar 

  58. Cooper Jr LT, ElAmm C. Giant cell myocarditis. diagnosis and treatment. Herz. 2012;37:632–6.

    Article  PubMed  Google Scholar 

  59. Caforio AL, Pankuweit S, Arbustini E, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2013;34:2636–48.

    Article  PubMed  Google Scholar 

  60. Caforio AL, Malipiero G, Marcolongo R, Iliceto S. Clinically suspected myocarditis with pseudo-infarct presentation: the role of endomyocardial biopsy. J Thorac Dis. 2017. doi:10.21037/jtd.2017.03.103.

    PubMed  PubMed Central  Google Scholar 

  61. •• Mavrogeni S, Markousis-Mavrogenis G, Koutsogeorgopoulou L. Cardiovascular magnetic resonance imaging pattern at the time of diagnosis of treatment naïve patients with connective tissue diseases. Int J Cardiol. 2017;S0167-5273(16):33153–9. An essential study exploring the role of baseline noninvasive cardiac imaging and screening in patients diagnosed with connective tissue diseases.

    Google Scholar 

  62. Szczeklik W, Miszalski-Jamka T, Mastalerz L, et al. Multimodality assessment of cardiac involvement in Churg-Strauss syndrome patients in clinical remission. Circ J. 2011;75:649–55.

    Article  PubMed  Google Scholar 

  63. Mavrogeni S, Ntoskas T, Gialafos E, et al. Silent myocarditis in myasthenia gravis. role of cardiovascular magnetic resonance imaging. Int J Cardiol. 2016;202:629–30.

    Article  PubMed  Google Scholar 

  64. Miszalski-Jamka T, Szczeklik W, Sokołowska B, et al. Cardiac involvement in Wegener's granulomatosis resistant to induction therapy. Eur Radiol. 2011;21:2297–304.

    Article  PubMed  PubMed Central  Google Scholar 

  65. Pieroni M, De Santis M, Zizzo G, et al. Recognizing and treating myocarditis in recent-onset systemic sclerosis heart disease: potential utility of immunosuppressive therapy in cardiac damage progression. Semin Arthritis Rheum. 2014;43:526–35.

    Article  PubMed  Google Scholar 

  66. Caforio AL, Tona F, Vinci A, et al. Acute biopsy-proven lymphocytic myocarditis mimicking Takotsubo cardiomyopathy. Eur J Heart Fail. 2009;11:428–31.

    Article  PubMed  Google Scholar 

  67. Ronco C, Di Lullo L. Cardiorenal syndrome. Heart Fail Clin. 2014;10:251–80.

    Article  PubMed  Google Scholar 

  68. Pankuweit S, Lüers C, Richter A, Ruppert V, Gelbrich G, Maisch B. Influence of different aetiologies on clinical course and outcome in patients with dilated cardiomyopathy. Eur J Clin Invest. 2015;45:906–17.

    Article  PubMed  Google Scholar 

  69. Anzini M, Merlo M, Sabbadini G, et al. Long-term evolution and prognostic stratification of biopsy-proven active myocarditis. Circulation. 2013;128:2384–94.

    Article  PubMed  Google Scholar 

  70. Grogan M, Redfield MM, Bailey KR, et al. Long-term outcome of patients with biopsy-proved myocarditis: comparison with idiopathic dilated cardiomyopathy. J Am Coll Cardiol. 1995;26:80–4.

    Article  CAS  PubMed  Google Scholar 

  71. Kindermann I, Kindermann M, Kandolf R, et al. Predictors of outcome in patients with suspected myocarditis. Circulation. 2008;118:639–48.

    Article  PubMed  Google Scholar 

  72. Magnani JW, Danik HJ, Dec Jr GW, DiSalvo TG. Survival in biopsy-proven myocarditis: a long-term retrospective analysis of the histopathologic, clinical, and hemodynamic predictors. Am Heart J. 2006;151:463–70.

    Article  PubMed  Google Scholar 

  73. Chopra H, Arangalage D, Bouleti C, et al. Prognostic value of the infarct- and non-infarct like patterns and cardiovascular magnetic resonance parameters on long-term outcome of patients after acute myocarditis. Int J Cardiol. 2016;212:63–9.

    Article  PubMed  Google Scholar 

  74. Bock CT, Klingel K, Kandolf R. Human parvovirus B19-associated myocarditis. N Engl J Med. 2010;362:1248–9.

    Article  CAS  PubMed  Google Scholar 

  75. • Greulich S, Kindermann I, Schumm J, et al. Predictors of outcome in patients with parvovirus B19 positive endomyocardial biopsy. Clin Res Cardiol. 2016;105:37–52. Recently published prospective study on the etiopathogenetic role of PVB19 in myocarditis.

    Article  PubMed  Google Scholar 

  76. Castellanos-Moreira R, Rodríguez-García S, López-Sobrino T, Capdevila A, Prieto-González S, Espinosa G. Successful extracorporeal membrane oxygenation in a patient with fulminant lupus myocarditis. Rev Esp Cardiol (Engl Ed). 2017;S1885–5857(16):30460–1.

    Google Scholar 

  77. Lorusso R, Centofanti P, Gelsomino S, et al. Venoarterial extracorporeal membrane oxygenation for acute fulminant myocarditis in adult patients: a 5-year multi-institutional experience. Ann Thorac Surg. 2016;101:919–26.

    Article  PubMed  Google Scholar 

  78. Priori SG, Blomström-Lundqvist C, Mazzanti A, et al. 2015 ESC Guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: The Task Force for the Management of Patients with Ventricular Arrhythmias and the Prevention of Sudden Cardiac Death of the European Society of Cardiology (ESC)Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC). Europace. 2015;17:1601–87.

    PubMed  Google Scholar 

  79. Ponikowski P, Voors AA, Anker SD, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail. 2016;18:891–975.

    Article  PubMed  Google Scholar 

  80. Woodruff JF. Viral myocarditis. a review. Am J Pathol. 1980;101(2):425–84.

    CAS  PubMed  PubMed Central  Google Scholar 

  81. Kühl U, Pauschinger M, Schwimmbeck PL, et al. Interferon-beta treatment eliminates cardiotropic viruses and improves left ventricular function in patients with myocardial persistence of viral genomes and left ventricular dysfunction. Circulation. 2003;107:2793–8.

    Article  PubMed  CAS  Google Scholar 

  82. Chaudhuri A, Dooris M, Woods ML. Non-rheumatic streptococcal myocarditis - warm hands, warm heart. J Med Microbiol. 2013;62:169–72.

    Article  PubMed  Google Scholar 

  83. •• Jensen LD, Marchant DJ. Emerging pharmacologic targets and treatments for myocarditis. Pharmacol Ther. 2016;161:40–51. Excellent up-to-date review on possible therapeutic strategies and tools in myocarditis patients.

    Article  CAS  PubMed  Google Scholar 

  84. Lynch 3rd JP, Hwang J, Bradfield J, Fishbein M, Shivkumar K, Tung R. Cardiac involvement in sarcoidosis: evolving concepts in diagnosis and treatment. Semin Respir Crit Care Med. 2014;35:372–90.

    Article  PubMed  PubMed Central  Google Scholar 

  85. Pierrot-Deseilligny Despujol C, Pouchot J, Pagnoux C, Coste J, Guillevin L. Predictors at diagnosis of a first Wegener's granulomatosis relapse after obtaining complete remission. Rheumatology (Oxford). 2010;49:2181–90.

    Article  Google Scholar 

  86. • Luconi N, Risse J, Busato T, et al. Myocarditis in a young man with adult onset Still's disease successfully treated with Il-1 blocker. Int J Cardiol. 2015;189:220–2. Interesting case report on the potential use of highly technological biological agents in the setting of Still’s disease related myocarditis.

    Article  CAS  PubMed  Google Scholar 

  87. Kim HK, Kim KI, Jung SW, et al. Successfully treated acute fulminant myocarditis induced by ulcerative colitis with extracorporeal life support and infliximab. J Cardiovasc Ultrasound. 2016;24:163–7.

    Article  PubMed  PubMed Central  Google Scholar 

  88. Noji Y. Anakinra in fulminant myocarditis: targeting interleukin-1 and the inflammasome formation. Crit Care Med. 2016;44:1630–1.

    Article  PubMed  Google Scholar 

  89. Robinson JL, Hartling L, Crumley E, Vandermeer B, Klassen TP. A systematic review of intravenous gamma globulin for therapy of acute myocarditis. BMC Cardiovasc Disord. 2005;5:12.

    Article  PubMed  PubMed Central  Google Scholar 

  90. McNamara DM, Holubkov R, Starling RC, et al. Controlled trial of intravenous immune globulin in recent-onset dilated cardiomyopathy. Circulation. 2001;103:2254–9.

    Article  CAS  PubMed  Google Scholar 

  91. Goland S, Czer LS, Siegel RJ, et al. Intravenous immunoglobulin treatment for acute fulminant inflammatory cardiomyopathy: series of six patients and review of literature. Can J Cardiol. 2008;24:571–4.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  92. Suri V, Varma S, Joshi K, Malhotra P, Kumari S, Jain S. Lupus myocarditis: marked improvement in cardiac function after intravenous immunoglobulin therapy. Rheumatol Int. 2010;30:1503–5.

    Article  PubMed  Google Scholar 

  93. Pecoraro A, Crescenzi L, Carucci L, Genovese A, Spadaro G. Heart failure not responsive to standard immunosuppressive therapy is successfully treated with high dose intravenous immunoglobulin therapy in a patient with Eosinophilic Granulomatosis with Polyangiitis (EGPA). Int Immunopharmacol. 2017;45:13–5.

    Article  CAS  PubMed  Google Scholar 

  94. Nash CL, Panaccione R, Sutherland LR, Meddings JB. Giant cell myocarditis, in a patient with Crohn's disease, treated with etanercept--a tumour necrosis factor-alpha antagonist. Can J Gastroenterol. 2001;15:607–11.

    Article  CAS  PubMed  Google Scholar 

  95. Cavalli G, Pappalardo F, Mangieri A, Dinarello CA, Dagna L, Tresoldi M. Treating life-threatening myocarditis by blocking interleukin-1. Crit Care Med. 2016;44:e751–4.

    Article  CAS  PubMed  Google Scholar 

  96. Toscano G, Tartaro P, Fedrigo M, Angelini A, Marcolongo R. Rituximab in recurrent idiopathic giant cell myocarditis after heart transplantation: a potential therapeutic approach. Transpl Int. 2014;27:e38–42.

    Article  CAS  PubMed  Google Scholar 

  97. Evans JD, Pettit SJ, Goddard M, Lewis C, Parameshwar JK. Alemtuzumab as a novel treatment for refractory giant cell myocarditis after heart transplantation. J Heart Lung Transplant. 2016;35:256–8.

    Article  PubMed  Google Scholar 

  98. Mason JW, O'Connell JB, Herskowitz A, et al. A clinical trial of immunosuppressive therapy for myocarditis. the Myocarditis Treatment Trial Investigators. N Engl J Med. 1995;333:269–75.

    Article  CAS  PubMed  Google Scholar 

  99. Frustaci A, Russo MA, Chimenti C. Randomized study on the efficacy of immunosuppressive therapy in patients with virus-negativeinflammatory cardiomyopathy: the TIMIC study. Eur Heart J. 2009;30:1995–2002.

    Article  CAS  PubMed  Google Scholar 

  100. •• Escher F, Kühl U, Lassner D, et al. Long-term outcome of patients with virus-negative chronic myocarditis or inflammatory cardiomyopathy after immunosuppressive therapy. Clin Res Cardiol. 2016;105:1011–20. Critical observational experience on the safety and utility of immunosuppressive therapy in myocarditis patients to allow recovery of ventricular systolic function and prevent progression of myocarditis.

    Article  CAS  PubMed  Google Scholar 

  101. Caforio ALP, Testolina M, Schiavo A, Marcolongo R, Iliceto S. Endomyocardial biopsy should be performed in every patient with suspected myocarditis. G Ital Cardiol (Rome). 2015;16:533–8.

    Google Scholar 

  102. • Weitsman T, Weisz G, Keren A, Hasin T. Prompt benefit of early immunosuppressive therapy in acute lymphocytic myocarditis with persistent heart failure. Clin Res Cardiol. 2016;105:794–6. Interesting case report showing early feasibility and clinical utility of immunosuppressive therapy in acute myocarditis presenting with heart failure phenotype.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Cardiology, Department of Cardiological, Thoracic and Vascular Sciences, Centro “V. Gallucci”, University of Padova-Policlinico, Via Giustiniani, 2, 35128, Padova, Italy

    A. L. P. Caforio & S. Iliceto

  2. Hematology and Clinical Immunology, Department of Medicine, University of Padua, Padua, Italy

    G. Malipiero & R. Marcolongo

Authors
  1. A. L. P. Caforio
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Malipiero
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. R. Marcolongo
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Iliceto
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. L. P. Caforio.

Ethics declarations

Conflict of Interest

Alida Linda Patrizia Caforio, Renzo Marcolongo, Giacomo Malipiero, and Sabino Iliceto declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Myocardial Disease

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Caforio, A.L.P., Malipiero, G., Marcolongo, R. et al. Myocarditis: A Clinical Overview. Curr Cardiol Rep 19, 63 (2017). https://doi.org/10.1007/s11886-017-0870-x

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11886-017-0870-x

Keywords

Search

Navigation