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The spectrum of myocarditis: from pathology to the clinics

  • Ornella LeoneEmail author
  • Maurizio Pieroni
  • Claudio Rapezzi
  • Iacopo Olivotto
Review and Perspectives
Part of the following topical collections:
  1. Quality in Pathology

Abstract

Myocarditis is an inflammatory disease of the myocardium, which may occur in isolation or as part of systemic infectious/immune/autoimmune conditions, characterized by vast aetiologic, clinical and histopathologic heterogeneity. The broad spectrum of myocarditis can be categorized according to the prevalent histopathologic pattern including lymphocytic, lympho-histiocytic, eosinophilic and neutrophilic forms, giant cell myocarditis and myocarditis with granulomata. Diverse histopathologic substrates generally reflect different aetiologies and pathogenetic mechanisms and may be critical to clinical decision-making. Active vasculitis, when present, completes the inflammatory spectrum. Unfortunately, the correlation of histopathologic patterns, clinical presentation and disease course in myocarditis is still largely unresolved, due to limited availability of bioptic samples at specific stages of disease and impracticality of serial sampling. We here review the elements supporting an aetiology-driven diagnostic work-up in myocarditis, emphasizing the importance of integrating pathologic studies with clinical features and information derived from multimodality imaging. Furthermore, we explore myocardial inflammation in genetic cardiomyopathies, its role in driving clinical variability and the potential of transcriptomic and proteomic analysis in our understanding of these complex interrelations.

Keywords

Myocarditis Histopathology Viruses Immune-autoimmune Aetiology-driven diagnostic work-up 

Abbreviations

cMRI

Cardiac magnetic resonance imaging

ICD

Implantable cardioverter defibrillator

EMB

Endomyocardial biopsy

EGPA

Eosinophilic granulomatosis with polyangiitis

ESC

European Society of Cardiology

GCM

Giant cell myocarditis

HSM

Hypersensitivity myocarditis

HES

Idiopathic hypereosinophilic syndrome

IHC

Immunohistochemistry

LM

Lymphocytic myocarditis

PCR

Polymerase chain reaction

SCD

Sudden cardiac death

SLE

Systemic lupus erythematosus

TM

Toxic myocarditis

Notes

Acknowledgments

Iacopo Olivotto was supported by the European Union’s Horizon 2020 Research and Innovation Programme under Grant Agreement no. 777204: ‘SILICOFCM - In Silico trials for drug tracing the effects of sarcomeric protein mutations leading to familial cardiomyopathy’; by the Italian Ministry of Health (Left ventricular hypertrophy in aortic valve disease and hypertrophic cardiomyopathy: genetic basis, biophysical correlates and viral therapy models (RF-2013-02356787), and NET-2011-02347173 (Mechanisms and treatment of coronary microvascular dysfunction in patients with genetic or secondary left ventricular hypertrophy).

Contributions

All individuals listed as co-authors of the manuscript (Ornella Leone, Maurizio Pieroni, Claudio Rapezzi and Iacopo Olivotto) gave substantial contributions to the conception or design of the work and to drafting the work or revising it critically for important intellectual content. All co-authors (Ornella Leone, Maurizio Pieroni, Claudio Rapezzi and Iacopo Olivotto) gave final approval of the version to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work be appropriately investigated and resolved.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Cardiovascular Pathology Unit, Department of PathologySant’Orsola-Malpighi University HospitalBolognaItaly
  2. 2.Cardiovascular Department, San Donato HospitalArezzoItaly
  3. 3.Cardiology, Department of Experimental Diagnostic and Specialty MedicineAlma Mater Studiorum-University of BolognaBolognaItaly
  4. 4.Cardiomyopathy UnitCareggi University HospitalFlorenceItaly

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