Myocarditis and autoimmunity

Area of Science:

• Cardiology
• Immunology
• Pathology

Background:

• Autoimmune myocarditis presents with heterogeneous etiologies, including viral infections and systemic autoimmune diseases.
• Immune activation from therapies like immune checkpoint inhibitors and vaccines can precipitate myocarditis and other immune-related adverse events.
• Host genetic factors, particularly the major histocompatibility complex (MHC), influence myocarditis type and severity, with non-MHC genes also potentially contributing to susceptibility.

Purpose of the Study:

• This review synthesizes current knowledge on the etiology, pathogenesis, diagnosis, and treatment of autoimmune myocarditis.
• The focus is on viral infections, autoimmunity, and the role of biomarkers in myocarditis.
• To provide an updated perspective on managing this complex cardiac condition.

Main Methods:

• Comprehensive literature review of autoimmune myocarditis.
• Analysis of etiological factors, including infections and autoimmune triggers.
• Evaluation of diagnostic modalities and emerging biomarkers.

Main Results:

• Endomyocardial biopsy is not consistently the gold standard for myocarditis diagnosis.
• Cardiac magnetic resonance imaging (CMR) shows utility in diagnosing autoimmune myocarditis.
• Novel biomarkers for inflammation and myocyte injury, when assessed concurrently, show promise for diagnosis.

Conclusions:

• Accurate diagnosis of the etiologic agent is crucial for effective treatment.
• Tailoring treatment to the specific stage of immune and inflammatory processes is essential.
• Future strategies should integrate advanced imaging and biomarker data for personalized myocarditis management.