Myocarditis in systemic immune-mediated diseases: Prevalence, characteristics and prognosis. A systematic review

Role of Endomyocardial Biopsy in Diagnostics of Myocarditis

“…The diagnostic yield is higher when EMB is performed within the first two weeks of the onset of clinical symptoms. Risk of complications is lower with EchoCG guidance and if hemodynamic stability has been achieved at least 24 h before [ 19 , 20 ]. At least five separate sample sites have been suggested to improve biopsy informativeness and correspondence with Dallas criteria, keeping in mind that autopsy studies have shown the criteria lacking sensitivity not only due to the inflammatory process being spatially heterogeneous but transient as well, with occasionally fast development of fibrosis, making it difficult to distinguish its genesis histologically from other possible causes [ 21 ].…”

“…At least five separate sample sites have been suggested to improve biopsy informativeness and correspondence with Dallas criteria, keeping in mind that autopsy studies have shown the criteria lacking sensitivity not only due to the inflammatory process being spatially heterogeneous but transient as well, with occasionally fast development of fibrosis, making it difficult to distinguish its genesis histologically from other possible causes [ 21 ]. A synergy of ECG and imaging methods such as EchoCG, CMR and electroanatomic mapping is advised for the best guidance of higher quality biopsy sampling [ 20 , 22 ].…”

“…Statistical incidence of systemic immune-mediated myocarditis remains unknown, as the exact etiology often remains undetermined. Sarcoidosis, systemic lupus erythematosus, systemic sclerosis and disorders presenting with hypereosinophilic syndrome represent increasingly recognized diseases that can cause myocarditis [ 2 , 20 ].…”

“…Serological markers such as anti-heart autoantibodies (AHA) and anti-intercalated disk autoantibodies (AIDA) show promise for patient selection, as they are found only upon cardiac involvement. Starting the treatment even in cases of suspicion and before systolic dysfunction can be detected by an EchoCG is known to ensure an improved clinical outcome, independently of other parameters [ 20 , 89 , 90 ]. Even though EMB remains the golden diagnostic standard to confirm cardiac involvement, its performance is rarely discussed in studies, with reports of low sensitivity (20–30%, due to the patchy distribution of the process), in comparison to non-invasive methods.…”

The mosaic of autoimmunity – Finally discussing in person. The 13th international congress on autoimmunity 2022 (AUTO13) Athens

“…The importance of autoimmune mechanisms and diseases, in almost every domain in medicine cannot be overemphasized. For instance, autoimmunity has been linked to all body systems, almost with no exception [ [2] , [3] , [4] ]. Moreover, early in the pandemic of COVID-19, the association of COVID-19 with autoimmunity has been thoroughly reported in the medical literature [ 5 , 6 ].…”