Myocarditis: update on imaging and contemporary management 

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Prof. Christina Basso, pathologist, from Padua opened the session by providing newest insights into the gold standard for the diagnosis of myocarditis. But first, she stressed the fact that myocarditis is the etiology for 1 out of 10 sudden cardiac deaths in the young. Given the broad variety of possible agents causing myocarditis, only endomyocardial biopsy (EMB) is able to yield the diagnosis. Prof. Basso then elegantly illustrated that the Dallas criteria (defined in 1987) underestimate the prevalence of myocarditis, and the new gold standard must add molecular analyses and immuno-histochemistry to the histological criteria. With these tools, viruses are detectable in up to 42% in children with myocarditis and of these, adeno- and influenza-viruses can account for up to 60%.

Prof. Fausto Pinto, Lisbon, then presented echocardigraphic data of myocarditis, underlining that often, subtle changes in function and sometimes thickened myocardial walls can give a hint for the presence of myocarditis. He then also pointed out that the sensitivity to diagnose EMB ranges in the literature from 9-70%. Here sampling errors might play a role.

Dr. Heiko Marholdt from Stuttgart then demonstrated convincing cases investigated by cardiac Magnetic Resonance (CMR), where inflammatory foci can be detected with high sensitivities and specificities of 76% and 91%, respectively (meta-analysis) versus EMB. Also, T2-weighted imaging by CMR for oedema detection may add information in certain cases.

Prof. Schultheiss from Berlin underlined then the importance of virus persistence predicting a bad outcome. Also, expression of adhesion molecules correlates with virus persistence. With virus persistence, there might be an option for interferon-beta treatment in the future, while in virus-negative cases, immunosuppression might be indicated.

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