title: Myocarditis in Clinical Practice.
abstract: Myocarditis is a polymorphic disease characterized by great variability in clinical presentation and evolution. Patients presenting with severe left ventricular dysfunction and life-threatening arrhythmias represent a demanding challenge for the clinician. Modern techniques of cardiovascular imaging and the exhaustive molecular evaluation of the myocardium with endomyocardial biopsy have provided valuable insight into the pathophysiology of this disease, and several clinical registries have unraveled the disease's long-term evolution and prognosis. However, uncertainties persist in crucial practical issues in the management of patients. This article critically reviews current information for evidence-based management, offering a rational and practical approach to patients with myocarditis. For this review, we searched the PubMed and MEDLINE databases for articles published from January 1, 1980, through December 31, 2015, using the following terms: myocarditis, inflammatory cardiomyopathy, and endomyocardial biopsy. Articles were selected for inclusion if they represented primary data or were review articles published in high-impact journals. In particular, a risk-oriented approach is proposed. The different patterns of presentation of myocarditis are classified as low-, intermediate-, and high-risk syndromes according to the most recent evidence on prognosis, clinical findings, and both invasive and noninvasive testing, and appropriate management strategies are proposed for each risk class.
authors.affiliation: Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy. Electronic address: gianfranco.sinagra@asuits.sanita.fvg.it.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Sinagra
authors.affiliation: Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Anzini
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
authors.forename: Naveen L
authors.initials: NL
authors.lastname: Pereira
authors.affiliation: Institute of Pathological Anatomy and Histology, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors.forename: Rossana
authors.initials: R
authors.lastname: Bussani
authors.affiliation: Cardiovascular Sciences Research Centre, St George's University of London, London, UK.
authors.forename: Gherardo
authors.initials: G
authors.lastname: Finocchiaro
authors.affiliation: Cardiovascular Centre Aalst, OLV Clinic, Aalst, Belgium.
authors.forename: Jozef
authors.initials: J
authors.lastname: Bartunek
authors.affiliation: Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Merlo
mesh_terms: D001706:Biopsy / Q000379:methods*; D019317:Evidence-Based Medicine / Q000379:methods*; D006801:Humans; D009205:Myocarditis / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*