Immunomodulating and immunosuppressive therapies are recognized as effective treatments for virus-negative inflammatory cardiomyopathy, with endomyocardial biopsy guiding tailored treatment.
This review highlights the role of immunosuppressive therapies in specific etiologies of immune-mediated myocarditis and emphasizes the necessity of endomyocardial biopsy for tailored treatment.
Myocarditis is an inflammatory disease of the myocardium caused by infectious and noninfectious agents. Clinical manifestations range from mildly symptomatic forms to acute heart failure, cardiogenic shock, life-threatening arrhythmias and sudden death. Myocarditis is still a challenging diagnosis because of its wide variability in clinical presentation and unpredictable course. Moreover, a standardized, specific treatment in not yet available. Immunosuppressive treatment for virus-negative lymphocytic myocarditis is still controversial. Conversely, immunosuppression is well established in sarcoidosis, eosinophilic, giant-cell, drug hypersensitivity, and trauma-related myocarditis as well as lymphocytic myocarditis associated with connective tissue diseases or with the rejection of a transplanted heart. Recently, immunosuppressive therapy has been also recognized as an effective treatment in virus-negative inflammatory cardiomyopathy. The aim of this review is to underline the role of immunomodulating and immunosuppressive therapies in patients with immune-mediated myocarditis and illustrate the different treatment strategies depending on the etiology. An endomyocardial biopsy remains the gold standard for the diagnosis of myocarditis as well as for a tailored treatment.
Frustaci et al. (2024) conducted a review in Virus-negative immune-mediated myocarditis. Immunomodulating and immunosuppressive therapy was evaluated. Immunomodulating and immunosuppressive therapies are recognized as effective treatments for virus-negative inflammatory cardiomyopathy, with endomyocardial biopsy guiding tailored treatment.