Chronic Myocarditis: Modern View on the Problem of Diagnosis and Treatment

Introduction. Chronic myocarditis remains one of the most challenging problems of modern cardiology due to the difficulties of timely diagnosis, variability of clinical course and potentially unfavorable prognosis of the disease. Objective. The purpose of this work is to conduct a comprehensive analysis of modern scientific data on the epidemiology, etiopathogenesis, diagnosis and treatment of chronic myocarditis. Based on a systematic review of international clinical trials and meta-analyses, modern approaches to diagnosis verification, including the use of the latest biomarkers and imaging techniques, are summarized. Modern therapeutic strategies, including etiotropic, pathogenetic and symptomatic therapy, are reviewed in detail, and the results of recent clinical trials on the effectiveness of various treatment regimens are presented. Predictors of unfavorable prognosis are identified based on the analysis of data from the Ukrainian registry of myocarditis (n=1,500). Results. The analysis of the literature allows us to conclude that chronic myocarditis is a clinically variable disease with a predominantly viral and bacterial etiology. Diagnosis has a wide range of clinical and laboratory methods, but in turn remains a difficult task due to the nonspecificity of clinical manifestations and the limited availability of the “gold standard” – endomyocardial biopsy. The introduction of modern imaging methods, in particular cardiac magnetic resonance imaging with parametric mapping, has increased the accuracy of noninvasive diagnosis to 96%. The treatment of chronic myocarditis requires a personalized approach, taking into account the etiology, stage of the disease and the presence of complications. Modern therapeutic strategies include etiotropic (antiviral), pathogenetic (immunosuppressive), and symptomatic therapy. The results of recent randomized trials demonstrate the effectiveness of combined treatment regimens, but the optimal duration and sequence of therapeutic measures require further study.