Key result
Endomyocardial biopsy remains the gold standard for pediatric myocarditis as targeted therapies lack robust trial support.
Why the study?
Pediatric myocarditis is troublesome to diagnose and manage, with disease mechanisms that remain incompletely understood and therapeutic strategies that are controversial and unconfirmed by clinical trials.
This review highlights the critical role of multimodality diagnostic pathways, including endomyocardial biopsy and MRI, in pediatric myocarditis and underscores the urgent need for large clinical trials to establish targeted therapeutic strategies.
EMB and MRI guide pediatric myocarditis diagnosis; leaves open targeted therapies pending dedicated trials.
Myocarditis is an inflammatory disease of the myocardium that is troublesome to diagnose and manage, especially in children. Since the introduction of endomyocardial biopsy (EMB), new diagnostic tools have provided useful data. Especially when enhanced with immunohistochemistry and polymerase chain reaction (PCR) studies, EMB remains the gold standard for the diagnosis. Notably, cardiac magnetic resonance (MRI) is a non-invasive tool that can confirm the diagnosis and has a particular usefulness during the follow-up. The causes of myocarditis are heterogeneous (mostly viral in children). The course and outcome of the illness in the pediatric population represent a complex interaction between etiologic agents and the immune system, which is still not fully understood. The clinical presentation and course of myocarditis vary widely from paucisymptomatic illness to acute heart failure refractory to therapy, arrhythmias, angina-like presentation and sudden cardiac death. In this setting, cardiac biomarkers (i.e., troponins and BNP), although unspecific, can be used to support the diagnosis. Finally, the efficacy of therapeutic strategies is controversial and not confirmed by clinical trials. In this review, we summarized the milestones in diagnosis and provided an overview of the therapeutic options for myocarditis in children.
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Pomiato et al. (2022) conducted a review in Pediatric Myocarditis. Diagnosis and management of pediatric myocarditis was evaluated. Pediatric myocarditis is a heterogeneous inflammatory disease primarily of viral etiology, where endomyocardial biopsy remains the diagnostic gold standard while specific therapeutic strategies lack robust clinical trial confirmation.
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