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Cited by 76Viral Infections and Immunology ResearchKawasaki Disease and Coronary ComplicationsPericarditis and Cardiac Tamponade

Diagnostic Approach for Suspected Acute Myocarditis: Considerations for Standardization and Broadening Clinical Spectrum

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Martens, Pieter, Cooper, Leslie T., Tang, W. H. Wilson·2023·Journal of the American Heart Association
DOI 10.1161/jaha.123.031454PMC PMC10547314
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Abstract

Myocarditis is most recognized in patients with moderate to severe, recent‐onset heart failure. However, less typical presentations including myocardial infarction with normal coronary arteries and arrhythmias are important manifestations but less commonly recognized to be caused by myocarditis. Most cases of myocarditis can be self‐limiting without specific treatment; however, appropriate identification of risk during the diagnostic process of myocarditis and once a diagnosis is established is of primordial importance to identify patients in need for more specific follow‐up and management. We propose a flexible, multitiered approach to the diagnostic process, allowing for capturing of the spectrum of myocarditis at an early time‐point, individualized use of diagnostic resources through disease severity phenotyping, and providing structured follow‐up care once myocarditis is confirmed. Such diagnostic processes allow for identification of specific etiologies with potential therapeutic consequences or allows for the comprehension of disease chronicity by understanding genetic contributions or elements of persistent immune dysregulation and degree of cardiac damage. The article highlights the evolving field of immunophenotyping in myocarditis, generating a potential for the development of targeted therapeutic approaches. Currently long‐term follow‐up should be titrated to the refined risk assessments of patients with a diagnosis of myocarditis and includes arrhythmia monitoring and imaging when the results will likely impact management. Genetic testing should be considered in selected cases, and histologic diagnosis may be considered in nonresponders even at later stages.

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  • Lymphocytic myocarditis is primarily associated with viral infections, characterized by histological observations of myocardial infiltration predominantly by T lymphocytes.

    “Lymphocytic myocarditis is primarily associated with viral infections, characterized by histological observations of myocardial infiltration predominantly by T lymphocytes”

    From Autoimmune Myocarditis, Old Dogs and New Tricks. (2024) · cites this paper as [143]

    The table in “Challenges in Classifying Myocarditis” describes lymphocytic myocarditis as having a lymphocyte-predominant, nonischemic infiltrate. It does not specify that those lymphocytes are predominantly T cells or establish that lymphocytic myocarditis is primarily associated with viral infections; the paper classifies viral-positive myocarditis separately. Page numbers were not available in our copy. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Sarcoidosis is a systemic autoimmune syndrome characterized by nonnecrotizing granulomas in various organs including the lung and heart.

    “Sarcoidosis is a systemic autoimmune syndrome characterized by the formation of nonnecrotizing granulomas, a histological hallmark, found in various organs including the lung and heart.”

    From Autoimmune Myocarditis, Old Dogs and New Tricks. (2024) · cites this paper as [143]

    In “Challenges in Classifying Myocarditis” (page unavailable), the cardiac sarcoidosis table describes granulomas and says necrosis is normally absent, supporting the heart involvement and nonnecrotizing-granuloma portions of the claim. Our copy does not characterize sarcoidosis as a systemic autoimmune syndrome or state that granulomas occur in the lung and other organs; a reference title mentions pulmonary sarcoidosis but does not establish those broader claims. (LLM, conf=0.83)

    Experimental — accuracy not yet measured

  • Giant cell myocarditis shows myocardial infiltration of multinucleated giant cells along with lymphocytes and eosinophils.

    “Histopathologic observations reveal myocardial infiltration of multinucleated giant cells along with lymphocytes and eosinophils in this condition.”

    From Autoimmune Myocarditis, Old Dogs and New Tricks. (2024) · cites this paper as [143]

  • CMR has its highest sensitivity within the first 3 weeks after symptom onset in myocarditis.

    “The highest sensitivity of CMR is within the first 3 weeks after symptom onset”

    From Autoimmune Myocarditis, Old Dogs and New Tricks. (2024) · cites this paper as [143]

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Sorted by citations

Authors
Martens, P., Cooper, L. T., & Tang, W. H. W.
Affiliations
  • Cleveland Clinic (US)
  • Mayo Clinic (US)
Corresponding author
Tang, W. H. Wilson
ORCID
Venue
Journal of the American Heart Association
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2023-09-05
Volume
12
Issue
17
Pages
e031454-e031454
ISSN
2047-9980 (ISSN-L)
DOI
10.1161/jaha.123.031454
PMC
PMC10547314
OpenAlex
W4385897351
Cited by
76
References
3
Citations by year
2026: 29 · 2025: 32 · 2024: 14 · 2023: 1
FWCI
3.97
Type
journal article
Language
en
Open access
Licence
cc-by-nc-nd
Locations
  • Journal of the American Heart Association (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Funders
National Heart, Lung, and Blood Institute (R01HL146754)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Viral Infections and Immunology Research
  • Health Sciences › Medicine › Surgery › Kawasaki Disease and Coronary Complications
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Pericarditis and Cardiac Tamponade
Keywords
acute myocarditis, diagnostic approach, cardiac arrhythmias, heart failure, immunophenotyping, genetic testing, histopathological diagnosis, long-term follow-up, risk assessment, immune dysregulation, cardiac injury
MeSH terms
Genetic Testing, Heart, Humans, Myocarditis, Reference Standards, Immunophenotyping

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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