Four-stage classification of myocarditis proposed, from exposure to risk factors to advanced myocarditis
By Elana Gotkine HealthDay Reporter
TUESDAY, Dec. 17, 2024 (HealthDay News) — In a 2024 guidance document issued by the American College of Cardiology and published online Dec. 10 in the Journal of the American College of Cardiology, recommendations are presented for the diagnosis and management of myocarditis.
Mark H. Drazner, M.D., from the University of Texas Southwestern Medical Center in Dallas, and colleagues present an expert consensus decision pathway for diagnosing and managing acute myocarditis in adult patients, reflecting recent advancements in clinical practice.
The authors note that clinicians should be aware of the three classic presentations of myocarditis: chest pain, heart failure/shock, and/or symptoms related to arrhythmia. High-sensitivity cardiac troponin (hs-cTn) is a common diagnostic test for suspected myocarditis, but some patients with myocarditis do not have elevated hs-cTn. Pivotal tests for diagnosis of myocarditis include cardiac magnetic resonance imaging and endomyocardial biopsy. A novel four-stage classification of myocarditis is suggested: Stage A relates to having or being exposed to risk factors; stage B to asymptomatic patients with evidence of myocardial inflammation; stage C to symptomatic myocarditis; and stage D to advanced myocarditis. The trajectories of the four stages need to be defined, including their risk for progression to chronic heart failure. For patients with symptomatic myocarditis, risk stratification guides the decision to refer to an advanced heart failure center with a multidisciplinary team. For myocarditis patients, follow-up does not end after two to three weeks, even if symptoms resolve, but should include two cardiac imaging studies at an early interval after diagnosis and at six months.
“Once a patient is diagnosed, clinicians can then follow the next four steps in the care pathway, including triaging the patient, obtaining pivotal diagnostic tests, providing appropriate therapies, and then longitudinal follow-up,” Drazner said in a statement.
Several authors disclosed ties to the pharmaceutical industry.
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