Management of myocarditis in clinical practice

Baritussio, Anna; Giordani, Andrea Silvio; Rizzo, Stefania; Masiero, Giulia; Iliceto, Sabino; Marcolongo, R

doi:10.23736/s2724-5683.21.05732-x

Cited by 7 publications

(7 citation statements)

References 43 publications

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“…Immunosuppressive therapy protocols in autoimmune/immune-mediated virus-negative myocarditis. Modified from Baritussio et al [84].…”

Section: Therapeutic Approaches: Targeting the Immune System To Heal ...mentioning

confidence: 99%

The Role of the Immune System in Pathobiology and Therapy of Myocarditis: A Review

Vicenzetto,

Giordani,

Menghi

et al. 2024

Biomedicines

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The role of the immune system in myocarditis onset and progression involves a range of complex cellular and molecular pathways. Both innate and adaptive immunity contribute to myocarditis pathogenesis, regardless of its infectious or non-infectious nature and across different histological and clinical subtypes. The heterogeneity of myocarditis etiologies and molecular effectors is one of the determinants of its clinical variability, manifesting as a spectrum of disease phenotype and progression. This spectrum ranges from a fulminant presentation with spontaneous recovery to a slowly progressing, refractory heart failure with ventricular dysfunction, to arrhythmic storm and sudden cardiac death. In this review, we first examine the updated definition and classification of myocarditis at clinical, biomolecular and histopathological levels. We then discuss recent insights on the role of specific immune cell populations in myocarditis pathogenesis, with particular emphasis on established or potential therapeutic applications. Besides the well-known immunosuppressive agents, whose efficacy has been already demonstrated in human clinical trials, we discuss the immunomodulatory effects of other drugs commonly used in clinical practice for myocarditis management. The immunological complexity of myocarditis, while presenting a challenge to simplistic understanding, also represents an opportunity for the development of different therapeutic approaches with promising results.

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“…Immunosuppressive therapy protocols in autoimmune/immune-mediated virus-negative myocarditis. Modified from Baritussio et al [84].…”

Section: Therapeutic Approaches: Targeting the Immune System To Heal ...mentioning

confidence: 99%

The Role of the Immune System in Pathobiology and Therapy of Myocarditis: A Review

Vicenzetto,

Giordani,

Menghi

et al. 2024

Biomedicines

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“…Regarding eosinophilic myocarditis, its therapy is also strongly based on corticosteroids; in accordance with the response, their dosage may be carefully tapered during follow up, and a steroid-sparing agent may be added, such as azathioprine or mycophenolate mofetil [ 5 , 176 ]. Importantly, if eosinophilic myocarditis appears in the context of EGPA, as its first presentation or in already-diagnosed patients, medical therapy should be modulated taking into account the underlying systemic disease [ 139 ].…”

Section: Autoimmune Myocarditis and Drug-induced Myocarditismentioning

confidence: 99%

Myocarditis: Etiology, Pathogenesis, and Their Implications in Clinical Practice

Brociek

Tymińska

Giordani

et al. 2023

Biology

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Myocarditis is an inflammatory disease of the myocardium caused by infectious or non-infectious agents. It can lead to serious short-term and long-term sequalae, such as sudden cardiac death or dilated cardiomyopathy. Due to its heterogenous clinical presentation and disease course, challenging diagnosis and limited evidence for prognostic stratification, myocarditis poses a great challenge to clinicians. As it stands, the pathogenesis and etiology of myocarditis is only partially understood. Moreover, the impact of certain clinical features on risk assessment, patient outcomes and treatment options is not entirely clear. Such data, however, are essential in order to personalize patient care and implement novel therapeutic strategies. In this review, we discuss the possible etiologies of myocarditis, outline the key processes governing its pathogenesis and summarize best available evidence regarding patient outcomes and state-of-the-art therapeutic approaches.

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“…In order to help clinicians to identify possible IT contraindications, a detailed “safety checklist” has been published [ 51 ] ( Table 2 ). This set of investigations is intended to be performed before starting IT in all patients, aiming at the identification of absolute contraindications and individual risks related to IT [ 52 ]. Patients should be screened for common latent infections and hidden malignancies, taking into account the individual patient’s characteristics, such as ethnicity, sex, and age (for example, reproductive age, or advanced age with increased frailty profile).…”

Section: Safety Check-list Before Starting It In Biopsy-proven Ai Myo...mentioning

confidence: 99%

Immunosuppressive Therapy of Biopsy-Proven, Virus-Negative, Autoimmune/Immune-Mediated Myocarditis—Focus on Azathioprine: A Review of Existing Evidence and Future Perspectives

Grzechocińska

Tymińska

Giordani

et al. 2023

Biology

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The use of immunosuppressive therapy (IT) in biopsy-proven, autoimmune/immune-mediated (AI), virus-negative myocarditis has become the standard of care. In particular, according to recent guidelines, azathioprine (AZA), in association with steroids, is a cornerstone of first-line therapy regimens. IT may have a crucial impact on the natural history of AI myocarditis, preventing its progression to end-stage heart failure, cardiovascular death, or heart transplantation, provided that strict appropriateness and safety criteria are observed. In particular, AZA treatment for AI virus-negative myocarditis requires the consideration of some crucial aspects regarding its pharmacokinetics and pharmacodynamics, as well as a high index of suspicion to detect its overt and/or subclinical side effects. Importantly, besides a tight teamwork with a clinical immunologist/immuno-rheumatologist, before starting IT, it is also necessary to carry out a careful “safety check-list” in order to rule out possible contraindications to IT and minimize patient’s risk. The aim of this review is to describe the pharmacological properties of AZA, as well as to discuss practical aspects of its clinical use, in the light of existing evidence, with particular regard to the new field of cardioimmunology.

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Management of myocarditis in clinical practice

Cited by 7 publications

References 43 publications

The Role of the Immune System in Pathobiology and Therapy of Myocarditis: A Review

The Role of the Immune System in Pathobiology and Therapy of Myocarditis: A Review

Myocarditis: Etiology, Pathogenesis, and Their Implications in Clinical Practice

Immunosuppressive Therapy of Biopsy-Proven, Virus-Negative, Autoimmune/Immune-Mediated Myocarditis—Focus on Azathioprine: A Review of Existing Evidence and Future Perspectives

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