Inflammatory cardiomyopathy: an update for clinicians

Inflammatory cardiomyopathy (CMP) is a myocardial disorder characterized by persistent inflammation leading to ventricular dysfunction and remodeling, often evolving from acute myocarditis of infectious or immune-mediated origin. Its pathogenesis is multifactorial, involving viral triggers, dysregulated immune responses, and genetic predispositions, resulting in a broad clinical spectrum-from infarct-like presentations and arrhythmias to heart failure presentations. Diagnosis requires an integrated approach using multiple diagnostic tools, integrating clinical evaluation, ECG, biomarkers, multimodality imaging, including cardiac magnetic resonance (CMR), and endomyocardial biopsy (EMB), which remains the gold standard for identifying histologic subtypes and guiding immunosuppressive therapy. Genetic testing should be included in the integrated diagnosis due to its key role in diagnosis, risk stratification, treatment decisions, and outcome prediction in complicated recurrent cases, since pathogenic variants in genes (e.g. titin, DSP, FLNC) may predispose individuals to myocardial inflammation and recurrent injury. The prognosis is influenced by initial severity, fibrosis extent, and underlying etiology. Ongoing research into precision diagnostics and immunomodulatory treatments promises to improve outcomes in this heterogeneous and potentially reversible condition.