TY - JOUR
T1 - Diagnosis and Management of Myocarditis in Children
T2 - A Scientific Statement from the American Heart Association
AU - Law, Yuk M.
AU - Lal, Ashwin K.
AU - Chen, Sharon
AU - Čiháková, Daniela
AU - Cooper, Leslie T.
AU - Deshpande, Shriprasad
AU - Godown, Justin
AU - Grosse-Wortmann, Lars
AU - Robinson, Joshua D.
AU - Towbin, Jeffrey A.
N1 - Publisher Copyright:
© 2021 Lippincott Williams and Wilkins. All rights reserved.
PY - 2021/8/10
Y1 - 2021/8/10
N2 - Myocarditis remains a clinical challenge in pediatrics. Originally, it was recognized at autopsy before the application of endomyocardial biopsy, which led to a histopathology-based diagnosis such as in the Dallas criteria. Given the invasive and low-sensitivity nature of endomyocardial biopsy, its diagnostic focus shifted to a reliance on clinical suspicion. With the advances of cardiac magnetic resonance, an examination of the whole heart in vivo has gained acceptance in the pursuit of a diagnosis of myocarditis. The presentation may vary from minimal symptoms to heart failure, life-threatening arrhythmias, or cardiogenic shock. Outcomes span full resolution to chronic heart failure and the need for heart transplantation with inadequate clues to predict the disease trajectory. The American Heart Association commissioned this writing group to explore the current knowledge and management within the field of pediatric myocarditis. This statement highlights advances in our understanding of the immunopathogenesis, new and shifting dominant pathogeneses, modern laboratory testing, and use of mechanical circulatory support, with a special emphasis on innovations in cardiac magnetic resonance imaging. Despite these strides forward, we struggle without a universally accepted definition of myocarditis, which impedes progress in disease-targeted therapy.
AB - Myocarditis remains a clinical challenge in pediatrics. Originally, it was recognized at autopsy before the application of endomyocardial biopsy, which led to a histopathology-based diagnosis such as in the Dallas criteria. Given the invasive and low-sensitivity nature of endomyocardial biopsy, its diagnostic focus shifted to a reliance on clinical suspicion. With the advances of cardiac magnetic resonance, an examination of the whole heart in vivo has gained acceptance in the pursuit of a diagnosis of myocarditis. The presentation may vary from minimal symptoms to heart failure, life-threatening arrhythmias, or cardiogenic shock. Outcomes span full resolution to chronic heart failure and the need for heart transplantation with inadequate clues to predict the disease trajectory. The American Heart Association commissioned this writing group to explore the current knowledge and management within the field of pediatric myocarditis. This statement highlights advances in our understanding of the immunopathogenesis, new and shifting dominant pathogeneses, modern laboratory testing, and use of mechanical circulatory support, with a special emphasis on innovations in cardiac magnetic resonance imaging. Despite these strides forward, we struggle without a universally accepted definition of myocarditis, which impedes progress in disease-targeted therapy.
KW - AHA Scientific Statements
KW - heart disease
KW - immune system diseases
KW - infections
KW - inflammation
KW - myocarditis
KW - pediatrics
KW - ventricular dysfunction
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U2 - 10.1161/CIR.0000000000001001
DO - 10.1161/CIR.0000000000001001
M3 - Review article
C2 - 34229446
AN - SCOPUS:85111570907
SN - 0009-7322
VL - 144
SP - E123-E135
JO - Circulation
JF - Circulation
IS - 6
ER -