Journal Article

Viral myocarditis—diagnosis, treatment options, and current controversies

Dec, G. William, Kontorovich, Amy R., Fuster, Valentin, Pollack, Ari

2015

Overview

Key Points Myocarditis is a frequent cause of dilated cardiomyopathy with heterogeneous clinical presentations and a wide range of clinical outcomes After infection by a cardiotropic virus, a maladaptive post-viral response ensues, which can cause myocardial cell dysfunction and compromised contractility Advances in our diagnostic capabilities using cardiac MRI as well as molecular detection of viruses by endomyocardial biopsy have improved our understanding and ability to characterize the disease Although comprehensive clinical recommendations specific to the treatment of myocarditis do not exist, modulation of the immune system is a promising therapeutic strategy as suggested by several randomized trials This Review explores the pathophysiology and natural history of viral myocarditis—a common cause of dilated cardiomyopathy and sudden cardiac death. Despite established standards, heterogeneity exists in the evaluation, diagnosis, and treatment of patients with myocarditis, and these aspects are also covered in detail by Pollack and colleagues. Investigational treatment options are highlighted. Myocarditis—a frequent cause of dilated cardiomyopathy and sudden cardiac death—typically results from cardiotropic viral infection followed by active inflammatory destruction of the myocardium. Characterization of this disease has been hampered by its heterogeneous clinical presentations and diverse aetiologies. Advances in cardiac MRI and molecular detection of viruses by endomyocardial biopsy have improved our ability to diagnose and understand the pathophysiological mechanisms of this elusive disease. However, therapeutic options are currently limited for both the acute and chronic phases of myocarditis. Several randomized, controlled trials have demonstrated potential benefit with immunosuppressive and immunomodulatory therapies, but further investigations are warranted. In this Review, we explore the pathophysiology, natural history, and modes of diagnosis of myocarditis, as well as evidence-based treatment strategies. As novel imaging techniques and human in vitro models of the disease emerge, the landscape of therapies for myocarditis is poised to improve.

• Publisher: Nature Publishing Group UK,Nature Publishing Group
• Subject: 59/57 / 692/4019/592/75/74 / 692/699/255 / 692/700/139 / 692/700/1421/1628 / 692/700/565/1436 / Antiviral Agents - therapeutic use / Cardiac Imaging / Cardiac Surgery / Cardiology / Case studies / Causes of / Diagnosis / Drug therapy / Humans / Immunosuppressive agents / Magnetic resonance imaging / Medicine & Public Health / Myocarditis / Myocarditis - diagnosis / Myocarditis - physiopathology / Myocarditis - therapy / Myocarditis - virology / review-article / Virus Diseases - diagnosis / Virus Diseases - physiopathology / Virus Diseases - therapy