Current evidence for diagnosis and management of cardiac vasculitis

Cardiac vasculitis represents a heterogeneous group of immune-mediated disorders that can involve the coronary vessels, myocardium, valvular apparatus and pericardial tissues. Despite its rarity, cardiac vasculitis may result in significant clinical sequelae such as acute coronary syndrome, heart failure, cardiac arrhythmias and pericarditis. Diagnosis is challenging because symptoms are often non-specific and overlap with other cardiovascular conditions. Early recognition is therefore crucial to prevent delayed treatment and disease progression. Advances in non-invasive multimodality imaging and collaborative cardio-rheumatology care have transformed recognition and management of this disease spectrum. Emerging techniques such as hybrid positron emission tomography-cardiac MRI and quantitative CT imaging permit in-vivo characterisation of inflammation. As per European Alliance of Associations for Rheumatology recommendations, treatment requires early intensive immunosuppression to induce remission, coupled with comprehensive cardiovascular risk management. Additional research is required to validate imaging-guided management algorithms, refine vasculitis-specific cardiovascular risk and define long-term outcomes across disease subtypes.