Advances in Management of Complicated Myocarditis and Inflammatory Cardiomyopathy

Purpose of review Aligned with the 2024 ACC/AHA and 2025 ESC guidelines, this review integrates emerging diagnostic and therapeutic strategies for complicated myocarditis and inflammatory cardiomyopathy. It proposes a risk-stratified, precision-based framework to guide management across the spectrum of clinical phenotypes. Recent findings Cardiac magnetic resonance remains the preferred noninvasive diagnostic tool, while endomyocardial biopsy has renewed interest with the introduction of quantitative grading frameworks such as the Seaport criteria. Genetic testing is increasingly used to identify pathogenic variants that modulate inflammatory responses and prognosis. Furthermore, ongoing clinical trials are exploring mechanism-specific immunomodulatory therapies, including interleukin-1 inhibitors, colchicine, and targeted treatments for immune checkpoint inhibitor associated disease as well as cardiac sarcoidosis. Summary Modern management has shifted toward a precision-based, risk stratified approach. Integrating advanced imaging, molecular testing, and histopathologic phenotyping allows for individualized treatment. Future research aims to bridge global diagnostic gaps and validate targeted therapies to improve long-term outcomes across the spectrum of inflammatory myocardial diseases.