Anna-Katharina Angerer, Gabija Mūraitė, Pranas Šerpytis
Abstract
Myocarditis diagnosis dates back to 1900 and has evolved significantly. The disease presents with a diverse clinical picture, complex pathophysiology, and various aetiologies, including recent challenges such as the COVID-19 pandemic, making diagnosis difficult. Therefore, an accurate differential diagnosis and newer diagnostic methods are essential. This review aims to analyse and compare diagnostic methods for myocarditis, emphasizing their role in a stepwise diagnostic approach and the relevance of novel techniques. A complete clinical evaluation that includes medical history, physical examination, biomarkers, electrocardiography and echocardiography is recommended in all patients with suspected myocarditis as the initial step in diagnostic assessment. In addition, revolutionary non-invasive imaging techniques have positioned cardiac magnetic resonance (CMR) as the primary tool for diagnosing myocarditis, while the role of endomyocardial biopsy (EMB) has changed. However, no single method is sufficient; instead, a multimodal diagnostic approach integrating clinical, imaging, and histological tools is essential for reliable diagnosis. zation with endomyocardial biopsy (EMB), which, alongside immunohistochemistry and PCR-based virus detection, remains a core diagnostic method. More recently, cardiac MRI (CMR), capable of detecting oedema and inflammation, has emerged as a powerful non- invasive tool. Innovations such as the Lake Louise Criteria and mapping techniques have significantly improved MRI diagnostic accuracy [1,2]. In addition, electroanatomic mapping (EAM) has been developed to enhance EMB sensitivity [3]. Given myocarditis’ complex and variable presentation [4], accurate diagnosis requires continual improvements, especially in light of evolving challenges such as the COVID-19 pandemic. Objective. This narrative review analyses the stepwise diagnostic approach to myocarditis. It focuses on both established and emerging diagnostic methods, especially imaging, endomyocardial biopsy (EMB), and novel techniques, while emphasizing the importance of differential diagnosis. The aim is to provide a comprehensive understanding of diagnostic advancements in myocarditis.
Keyword(s): Myocarditis, Diagnostic approach, Electroanatomic mapping, CCTA, Cardiac MRI, Dallas Criteria, Lake Louise Criteria, Infarction-like myocarditis.
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