Myocarditis is a complex inflammatory disease, usually occurring secondary to viral infections, autoimmune processes or toxic agents. Clinical presentations are multiple, including chest-pain, heart failure and a broad spectrum of arrhythmias. In turn, outcome is largely unpredictable, ranging from mild self-limiting disease, to chronic stage and progressive evolution towards dilated cardiomyopathy, to rapid adverse outcome in fulminant forms. Subsequently, myocarditis is often underdiagnosed and undertreated, and optimal diagnostic and therapeutic strategies are still to be defined. This study, both retrospective and prospective, originally single-center and subsequently upgraded to multicenter, aims at answering multiple questions about myocarditis, with special attention to its arrhythmic manifestations. 1. Optimal diagnostic workflow is still to be defined. In fact, although endomyocardial biopsy (EMB) is still the diagnostic gold standard, especially for aetiology identification, it is an invasive technique. Furthermore, it may lack sensitivity because of sampling errors. By converse, modern imaging techniques - cardiac magnetic resonance (CMR) in particular - have been proposed as alternative or complementary diagnostic tool in inflammatory heart disease. Other noninvasive diagnostic techniques, like delayed-enhanced CT (DECT) scan or position emission tomography (PET) scan, are under investigation. 2. Biomarkers to identify myocarditis aetiology, predisposition, prognosis and response to treatment are still to be defined. 3. Arrhythmic myocarditis is largely underdiagnosed and uninvestigated. Importantly, myocarditis presenting with arrhythmias requires specific diagnostic, prognostic and therapeutic considerations. At the group leader hospital, which is an international referral center for ventricular arrhythmias management and ablation, a relevant number of patients with unexplained arrhythmias had myocarditis as underlying aetiology. The experience of a dedicated third-level center is going to be shared with other centers, to considerably improve knowledge and management of arrhythmic myocarditis. 4. The role of CMR, as well as alternative noninvasive imaging techniques, in defining myocarditis healing is a relevant issue. In particular, optimal timing for follow-up diagnostic reassessment is still to be defined, in patients with myocarditis at different inflammatory stages, either with or without aetiology-dependent treatment. 5. Uniformly-designed studies are lacking, to compare myocarditis among different patient subgroups, differing by variables like: clinical presentations, myocarditis stage, associated cardiac or extra-cardiac diseases, aetiology-based treatment, associated arrhythmic manifestations, diagnostic workup, and devices or ablation treatment.
Age range
18 Years
Sex
ALL
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Occurrence of major cardiac events
Timeframe: By 12-month follow-up
Occurrence of major cardiac events
Timeframe: By 24-month follow-up
Occurrence of major cardiac events
Timeframe: By 3-year follow-up
Occurrence of major cardiac events
Timeframe: By 5-year follow-up
Occurrence of major cardiac events
Timeframe: By 7-year follow-up
Occurrence of major cardiac events
Timeframe: By 10-year follow-up
Assessment of diagnostic accuracy (in terms of true/false positive/negative rates) between EMB and second level imaging findings - Primary
Timeframe: At baseline assessment
Assessment of diagnostic accuracy (in terms of true/false positive/negative rates) between EMB and second level imaging findings - Primary
Timeframe: By 6-month follow-up
Assessment of diagnostic accuracy (in terms of true/false positive/negative rates) between EMB and second level imaging findings - Primary
Timeframe: By 12-month follow-up
Assessment of diagnostic accuracy (in terms of true/false positive/negative rates) between EMB and second level imaging findings - Primary
Timeframe: By 24-month follow-up
Assessment of diagnostic accuracy (in terms of true/false positive/negative rates) between EMB and second level imaging findings - Primary
Timeframe: By 3-year follow-up
Assessment of diagnostic accuracy (in terms of true/false positive/negative rates) between EMB and second level imaging findings - Primary
Timeframe: By 5-year follow-up
Assessment of diagnostic accuracy (in terms of true/false positive/negative rates) between EMB and second level imaging findings - Primary
Timeframe: By 10-year follow-up
Comparison of troponin values in patients with different aetiologies
Timeframe: At baseline assessment
Description of troponin values changes during follow-up
Timeframe: By 10-year follow-up
Comparison of creatine-phosphokinase values in patients with different aetiologies
Timeframe: At baseline assessment
Description of creatine-phosphokinase values changes during follow-up
Timeframe: By 10-year follow-up
Comparison of natriuretic peptides values in patients with different aetiologies
Timeframe: At baseline assessment
Description of natriuretic peptides values changes during follow-up
Timeframe: By 10-year follow-up
Comparison of C-reactive protein values in patients with different aetiologies
Timeframe: At baseline assessment
Description of C-reactive protein values changes during follow-up
Timeframe: By 10-year follow-up
Comparison of erythrocyte sedimentation rate values in patients with different aetiologies
Timeframe: At baseline assessment
Description of erythrocyte sedimentation rate values changes during follow-up
Timeframe: By 10-year follow-up
Comparison of procalcitonin values in patients with different aetiologies
Timeframe: At baseline assessment
Comparison of procalcitonin values in patients with different aetiologies
Timeframe: By 10-year follow-up
Comparison of serum uric acid values in patients with different aetiologies
Timeframe: At baseline assessment
Comparison of serum uric acid values in patients with different aetiologies
Timeframe: By 10-year follow-up
Comparison of leukocyte values in patients with different aetiologies
Timeframe: At baseline assessment
Comparison of leukocyte values in patients with different aetiologies
Timeframe: By 10-year follow-up
Comparison of hemoglobin values in patients with different aetiologies
Timeframe: At baseline assessment
Comparison of hemoglobin values in patients with different aetiologies
Timeframe: By 10-year follow-up
Comparison of platelet values in patients with different aetiologies
Timeframe: At baseline assessment
Comparison of platelet values in patients with different aetiologies
Timeframe: By 10-year follow-up
Comparison of thyroid function in patients with different aetiologies
Timeframe: At baseline assessment
Comparison of thyroid function in patients with different aetiologies
Timeframe: By 10-year follow-up
Comparison of organ damage in patients with different aetiologies
Timeframe: At baseline assessment
Comparison of organ damage in patients with different aetiologies
Timeframe: By 10-year follow-up
Reporting the results of autoimmunity screening
Timeframe: At baseline assessment
Reporting the results of autoimmunity screening
Timeframe: By 10-year follow-up
Reporting the results of infectious screening
Timeframe: At baseline assessment
Reporting the results of infectious screening
Timeframe: By 10-year follow-up
Reporting the results of toxicology screening
Timeframe: At baseline assessment
Reporting the results of toxicology screening
Timeframe: By 10-year follow-up
Reporting the results of genetic test screening
Timeframe: At baseline assessment
Reporting the results of genetic test screening
Timeframe: By 10-year follow-up
Validation of optimal management of arrhythmic myocarditis by comparing the occurrence of major cardiac events in patients undergoing different therapeutic strategies - Primary
Timeframe: By 10-year follow-up
Validation of optimal management of arrhythmic myocarditis by comparing the occurrence of major cardiac events in patients undergoing different therapeutic strategies - Primary
Timeframe: By 12-month follow-up
Validation of optimal management of arrhythmic myocarditis by comparing the occurrence of major cardiac events in patients undergoing different therapeutic strategies - Primary
Timeframe: By 24-month follow-up
Validation of optimal management of arrhythmic myocarditis by comparing the occurrence of major cardiac events in patients undergoing different therapeutic strategies - Primary
Timeframe: By 3-year follow-up
Validation of optimal management of arrhythmic myocarditis by comparing the occurrence of major cardiac events in patients undergoing different therapeutic strategies - Primary
Timeframe: By 5-year follow-up
Validation of optimal management of arrhythmic myocarditis by comparing the occurrence of major cardiac events in patients undergoing different therapeutic strategies - Primary
Timeframe: By 7-year follow-up
Evaluation of healing timing in myocarditis - Primary
Timeframe: By 1-month follow-up
Evaluation of healing timing in myocarditis - Primary
Timeframe: By 3-month follow-up
Evaluation of healing timing in myocarditis - Primary
Timeframe: By 6-month follow-up
Evaluation of healing timing in myocarditis - Primary
Timeframe: By 9-month follow-up
Evaluation of healing timing in myocarditis - Primary
Timeframe: By 12-month follow-up
Evaluation of healing timing in myocarditis - Primary
Timeframe: By 18-month follow-up
Evaluation of healing timing in myocarditis - Primary
Timeframe: By 24-month follow-up
Evaluation of healing timing in myocarditis - Primary
Timeframe: By 3-year follow-up
Evaluation of healing timing in myocarditis - Primary
Timeframe: By 5-year follow-up
Evaluation of healing timing in myocarditis - Primary
Timeframe: By 7-year follow-up
Evaluation of healing timing in myocarditis - Primary
Timeframe: By 10-year follow-up
Comparison of the incidence of major cardiac events in different patient subgroups - Primary
Timeframe: At baseline assessment
Comparison of the incidence of major cardiac events in different patient subgroups - Primary
Timeframe: By 12-month follow-up
Comparison of the incidence of major cardiac events in different patient subgroups - Primary
Timeframe: By 24-month follow-up
Comparison of the incidence of major cardiac events in different patient subgroups - Primary
Timeframe: By 3-year follow-up
Comparison of the incidence of major cardiac events in different patient subgroups - Primary
Timeframe: By 5-year follow-up
Comparison of the incidence of major cardiac events in different patient subgroups - Primary
Timeframe: By 7-year follow-up
Comparison of the incidence of major cardiac events in different patient subgroups - Primary
Timeframe: By 10-year follow-up