Phenotyping of giant cell myocarditis versus cardiac sarcoidosis using cardiovascular magnetic resonance

Ring-like late gadolinium enhancement: differential diagnosis and mimics

Advances in cardiac magnetic resonance have promoted tissue characterization with high spatial and contrast resolution, and late gadolinium enhancement (LGE) sequences have improved the detection of myocardial fibrosis. The distribution pattern of LGE facilitates differentiation between ischemic and nonischemic etiologies and aids in refining diagnoses within nonischemic cardiomyopathies, suggesting specific etiological factors. A distinctive nonischemic LGE pattern that has recently gained prominence is the ring-like pattern, defined as a subepicardial or mid-wall circumferential or semi-circumferential enhancement, which involves at least three contiguous segments within the same short-axis slice. Initially identified as a diagnostic marker for desmoplakin and filamin C-related cardiomyopathies, the pattern has been reported in nongenetic conditions; nevertheless, it remains an uncommon finding in these diseases. In this article, we aim to present the differential diagnoses of ring-like LGE and its mimics. The combination of epidemiological, clinical, electrocardiographic, and additional features enables a focused refinement of the differential diagnosis associated with ring-like LGE.

Management of cardiac sarcoidosis

Cardiac sarcoidosis (CS) is a form of inflammatory cardiomyopathy associated with significant clinical complications such as high-degree atrioventricular block, ventricular tachycardia, and heart failure as well as sudden cardiac death. It is therefore important to provide an expert consensus statement summarizing the role of different available diagnostic tools and emphasizing the importance of a multidisciplinary approach. By integrating clinical information and the results of diagnostic tests, an accurate, validated, and timely diagnosis can be made, while alternative diagnoses can be reasonably excluded. This clinical expert consensus statement reviews the evidence on the management of different CS manifestations and provides advice to practicing clinicians in the field on the role of immunosuppression and the treatment of cardiac complications based on limited published data and the experience of international CS experts. The monitoring and risk stratification of patients with CS is also covered, while controversies and future research needs are explored.

Diagnostic and management strategies in cardiac sarcoidosis

Cardiac sarcoidosis (CS) is increasingly recognized in the context of with otherwise unexplained electrical or structural heart disease due to improved diagnostic tools and awareness. Therefore, clinicians require improved understanding of this rare but fatal disease to care for these patients. The cardinal features of CS, include arrhythmias, atrio-ventricular conduction delay and cardiomyopathy. In addition to treatments tailored to these cardiac manifestations, immunosuppression plays a key role in active CS management. However, clinical trial and consensus guidelines are limited to guide the use of immunosuppression in these patients. This review aims to provide a practical overview to the current diagnostic challenges, treatment approach, and future opportunities in the field of CS.

Biomarkers in Acute Myocarditis and Chronic Inflammatory Cardiomyopathy: An Updated Review of the Literature

Myocarditis is a disease caused by cardiac inflammation that can progress to dilated cardiomyopathy, heart failure, and eventually death. Several etiologies, including autoimmune, drug-induced, and infectious, lead to inflammation, which causes damage to the myocardium, followed by remodeling and fibrosis. Although there has been an increasing understanding of pathophysiology, early and accurate diagnosis, and effective treatment remain challenging due to the high heterogeneity. As a result, many patients have poor prognosis, with those surviving at risk of long-term sequelae. Current diagnostic methods, including imaging and endomyocardial biopsy, are, at times, expensive, invasive, and not always performed early enough to affect disease progression. Therefore, the identification of accurate, cost-effective, and prognostically informative biomarkers is critical for screening and treatment. The review then focuses on the biomarkers currently associated with these conditions, which have been extensively studied via blood tests and imaging techniques. The information within this review was retrieved through extensive literature research conducted on major publicly accessible databases and has been collated and revised by an international panel of experts. The biomarkers discussed in the article have shown great promise in clinical research studies and provide clinicians with essential tools for early diagnosis and improved outcomes.