[ANMCO/SIC Consensus document on the management of myocarditis]

Area of Science:

• Cardiology
• Immunology
• Infectious Diseases

Background:

• Myocarditis is an inflammatory heart disease with diverse causes, including viral infections, autoimmune disorders, and drug reactions.
• It presents acutely or chronically, affecting younger individuals and men more frequently, with varied clinical outcomes.
• Risk factors for poor prognosis include reduced ejection fraction, heart failure, arrhythmias, and cardiogenic shock.

Purpose of the Study:

• To propose diagnostic strategies for identifying causes and risk factors of myocarditis.
• To outline potential treatments and referral guidelines for high-risk patients.
• To provide an expert consensus on managing myocarditis from an Italian perspective, integrating international guidelines.

Main Methods:

• Expert consensus document development by the Italian Association of Hospital Cardiologists (ANMCO) and Italian Society of Cardiology (SIC).
• Review of current scientific literature and international position statements.
• Proposal of diagnostic algorithms and management pathways for myocarditis.

Main Results:

• Identification of viral infections as common triggers, with emerging drug-related causes like immune checkpoint inhibitors.
• Stratification of patients based on risk factors for adverse outcomes.
• Recommendations on the role of endomyocardial biopsy versus cardiac magnetic resonance imaging for diagnosis.

Conclusions:

• Effective management of myocarditis requires timely diagnosis, risk stratification, and appropriate treatment.
• Cardiac magnetic resonance imaging can be a valuable tool, potentially reducing the need for invasive biopsy in select cases.
• This consensus provides a framework for managing myocarditis patients, emphasizing a multidisciplinary approach and adherence to evidence-based guidelines.