Myocarditis Diagnosis and Management Strategies

Myocarditis encompasses a heterogeneous group of inflammatory disorders of the myocardium with presentations ranging from subclinical disease to fulminant cardiogenic shock. Diagnosis relies on a combination of clinical assessment, electrocardiography, serum biomarkers and advanced imaging, most notably cardiovascular magnetic resonance (CMR) with tissue characterisation by T1/T2 mapping and late gadolinium enhancement. Endomyocardial biopsy remains the definitive diagnostic standard but is reserved for selected cases due to its invasiveness and sampling limitations. Management strategies are tailored to aetiology and severity: immunosuppressive regimens in autoimmune and eosinophilic forms; antiviral and immunomodulatory approaches in viral myocarditis; and mechanical circulatory support for patients with fulminant presentations. Emerging insights into genetic predisposition, molecular regulators such as microRNAs and drug‐induced injury inform personalised risk stratification and targeted therapies. A global focus on pharmacovigilance and multidisciplinary care pathways aims to improve outcomes across the spectrum of disease.

Research from Nature Portfolio

Large‐scale pharmacovigilance analysis of over 21 million safety reports has delineated 62 drugs associated with myocarditis, including antipsychotics, cytotoxic and immunotherapeutic agents. Temporal trends reveal a median onset of 15 days after drug initiation and overall mortality of 10.3 percent, underlining the need for early recognition and tailored monitoring in high‐risk populations. Complementing this, experimental work on microRNA‐155 has identified a pivotal role for this non-coding RNA in macrophage polarisation during viral myocarditis. Silencing of microRNA‐155 in murine models shifts macrophages towards an anti-inflammatory phenotype, attenuates myocardial injury and improves long-term function, highlighting a novel molecular target for future therapeutic development.

Myocarditis Diagnosis and Management Strategies publication trend

The graph below shows the total number of articles in myocarditis diagnosis and management strategies across all publications each year (not limited to Nature Index journals).

Technical terms

Cardiovascular magnetic resonance (CMR): Non-invasive imaging modality employing magnetic fields and contrast agents to assess cardiac anatomy, function and tissue characteristics.

Late gadolinium enhancement (LGE): CMR technique in which gadolinium contrast accumulates in areas of myocardial fibrosis or necrosis, highlighting scarred tissue.

Endomyocardial biopsy (EMB): Invasive procedure obtaining small samples of heart muscle for histopathological confirmation of inflammation or infection.

MicroRNA: Short non-coding RNA molecules that regulate gene expression post-transcriptionally and may serve as biomarkers or therapeutic targets.

Mechanical circulatory support (MCS): Device-based therapy (e.g. ventricular assist devices, extracorporeal life support) providing temporary haemodynamic support in severe cardiac dysfunction.

Pharmacovigilance: Systematic monitoring, detection and evaluation of adverse drug reactions to ensure medication safety.

References

1. Systematic analysis of drug-associated myocarditis reported in the World Health Organization pharmacovigilance database. Nature Communications (2022).
2. Silencing MicroRNA-155 Attenuates Cardiac Injury and Dysfunction in Viral Myocarditis via Promotion of M2 Phenotype Polarization of Macrophages. Scientific Reports (2016).
3. Genetic Architecture of Acute Myocarditis and the Overlap With Inherited Cardiomyopathy. Circulation (2022).
4. Fulminant myocarditis: a comprehensive review from etiology to treatments and outcomes. Signal Transduction and Targeted Therapy (2020).
5. Mechanical Unloading by Fulminant Myocarditis: LV-IMPELLA, ECMELLA, BI-PELLA, and PROPELLA Concepts. Journal of Cardiovascular Translational Research (2018).
6. Current Diagnostic and Therapeutic Aspects of Eosinophilic Myocarditis. BioMed Research International (2016).
7. Cardiovascular magnetic resonance risk stratification in patients with clinically suspected myocarditis. Journal of Cardiovascular Magnetic Resonance (2014).
8. Diagnostic and prognostic role of electrocardiogram in acute myocarditis: A comprehensive review. Annals of Noninvasive Electrocardiology (2019).