Management of Acute Myocarditis and Chronic Inflammatory Cardiomyopathy: An Expert Consensus Document.
Management of Acute Myocarditis and Chronic Inflammatory Cardiomyopathy: An Expert Consensus Document.
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DOI：
10.1161/circheartfailure.120.007405
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发表时间：
2020-11
期刊：
影响因子：
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通讯作者：
Camici PG
中科院分区：
文献类型：
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作者：
Ammirati E;Frigerio M;Adler ED;Basso C;Birnie DH;Brambatti M;Friedrich MG;Klingel K;Lehtonen J;Moslehi JJ;Pedrotti P;Rimoldi OE;Schultheiss HP;Tschöpe C;Cooper LT Jr;Camici PG
补充数字内容可在文本中找到。心肌炎是一种心脏炎症性疾病，可能是由于感染、免疫系统激活或暴露于药物而发生。由于心脏磁共振成像的引入，心肌炎的诊断发生了变化。我们提出了一份专家共识文件，旨在总结与心肌炎相关的常用术语，同时强调一些有争议和不确定性的领域以及未满足的临床需求。事实上，关于决定从初始触发到心肌炎症以及从急性心肌损伤到慢性心室功能障碍的转变的机制仍然存在争议。目前还不确定哪些病毒（除了肠道病毒）会导致直接的组织损伤，作为免疫介导的损伤的触发器，或两者兼而有之。关于术语，心肌炎可以根据病因学、阶段和疾病的严重程度、主要症状和病理结果来表征。临床上，急性心肌炎（AM）意味着从症状发作到诊断的时间很短（通常<1个月）。相比之下，慢性炎性心肌病表明心肌炎症伴扩张型心肌病或运动功能减退非扩张型表型，其在晚期演变为纤维化而无可检测的炎症。AM和慢性炎症性心肌病的诊断和治疗建议主要基于专家意见，因为该领域缺乏精心设计的当代临床研究。我们将提供一个共同的和实用的方法来诊断和管理病人，欧洲和美国之间的科学声明在这个问题上的根本差异。我们解释了组织学的作用，定义亚型心肌炎及其预后和治疗的影响。
Supplemental Digital Content is available in the text. Myocarditis is an inflammatory disease of the heart that may occur because of infections, immune system activation, or exposure to drugs. The diagnosis of myocarditis has changed due to the introduction of cardiac magnetic resonance imaging. We present an expert consensus document aimed to summarize the common terminology related to myocarditis meanwhile highlighting some areas of controversies and uncertainties and the unmet clinical needs. In fact, controversies persist regarding mechanisms that determine the transition from the initial trigger to myocardial inflammation and from acute myocardial damage to chronic ventricular dysfunction. It is still uncertain which viruses (besides enteroviruses) cause direct tissue damage, act as triggers for immune-mediated damage, or both. Regarding terminology, myocarditis can be characterized according to etiology, phase, and severity of the disease, predominant symptoms, and pathological findings. Clinically, acute myocarditis (AM) implies a short time elapsed from the onset of symptoms and diagnosis (generally <1 month). In contrast, chronic inflammatory cardiomyopathy indicates myocardial inflammation with established dilated cardiomyopathy or hypokinetic nondilated phenotype, which in the advanced stages evolves into fibrosis without detectable inflammation. Suggested diagnostic and treatment recommendations for AM and chronic inflammatory cardiomyopathy are mainly based on expert opinion given the lack of well-designed contemporary clinical studies in the field. We will provide a shared and practical approach to patient diagnosis and management, underlying differences between the European and US scientific statements on this topic. We explain the role of histology that defines subtypes of myocarditis and its prognostic and therapeutic implications.