The widening gap between tools at hand of many clinicians to diagnose myo- or pericarditis and the diagnostic possibilities of highly specialised centres dedicated to cardiomyopathies
During this very well attended session clinicians eager to know how to introduce new diagnostic and therapeutic methods in their daily clinical practice, in fact, learnt how useful for their patients it might be to take a refined diagnostic approach in patients with myocarditis and pericarditis. The detailed clinical-ECG-echo diagnostic work-up is needed in patients suspected of myocarditis, said Dr Claudio Rapezzi from Bologna during his lecture on "Current diagnostic approach to myocarditis". Commonly used biomarkers that are highly sensitive, but of low specificity in the diagnosis of myocarditis may be helpful to make a correct diagnosis.
Although findings on echocardiograms such as normal function or segmental hypo-akinesia are non-specific in the diagnosis of myocarditis, Dr Buser, from Basel stressed that combined clinical and echo assessment may lead to the correct diagnosis. If areas of late enhancement have been shown on CMR, the diagnosis of myocarditis can be made with high sesnitivity and adequate specificity.
Both Dr Rapezzi and Prof. Schultheiss from Berlin showed elegantly the role of endomyocardial biopsy as a potent tool in the diagnosis of myocarditis, and in biopsy-guided therapy. Myocardial tissue work-up involves not only histopatology, but also immunohistology to define later phases of the disease and PCR technique, helping us to identify the viral genome not only in blood samples but also in endomydocardial biopsy. Quantitative PCR allows us to learn how many copies of viral genome are present in tissue or in blood.
For example, Viral myocarditis can be diagnosed if there is positive histological/immunohistological diagnosis, viral genome is present in much higher amounts in endomyocardial tissue than in blood samples.
As far as medical therapy is concerned, there are as yet no convincing controlled trials of immunosuppression or antiviral strategy. So, the treatment is symptomatic, apart from patients in whom you can proceed with biopsy-guided therapy.
Prof. Maisch stressed how important is not to neglect even small pericardial effusion. Up to 48% of his patients with pericarditis have the diagnosis of cancer. Some patients require the diagnosis with pericardial biopsy, worked-up exactly in the same way as for myocarditis.
In the treatment of pericarditis said Prof. Seferovic from Belgrade, there are new controlled trials. Of particular importance is proving that combined colchicine plus rosuvastatin treatment is superior to the treatment with colchicine alone in pericarditis.