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Ätiologie, Diagnose, Management und Therapie der Myokarditis

Positionspapier der ESC Working Group on Myocardial and Pericardial Diseases

Etiology, diagnosis, management, and treatment of myocarditis

Position paper from the ESC Working Group on Myocardial and Pericardial Diseases

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Zusammenfassung

Trotz großer Fortschritte in der Pathophysiologie und Ätiologie der Myokarditis ist auch heute im klinischen Alltag die Diagnose einer Myokarditis schwierig zu stellen. Häufig bleibt es bei einer reinen Verdachtsdiagnose. Unklarheiten bezüglich der anzuwendenden diagnostischen Kriterien und der möglicherweise daraus resultierenden therapeutischen Konsequenzen erschweren eine endgültige Diagnosestellung. Diesem klinischen Problem hat sich die Arbeitsgruppe Myocardial and Pericardial Diseases der Europäischen Gesellschaft für Kardiologie (ESC) gestellt und eine Arbeitsgruppe aus Experten eingerichtet, die die aktuellen Daten zur klinischen Präsentation, Diagnostik und Behandlung von Patienten mit Myokarditis zusammenstellen sollte, um anschließend im Konsens diagnostische Kriterien sowie einen (Be-)Handlungspfad für Patienten mit klinischem Verdacht auf Myokarditis zu erarbeiten. Ziel war es, die Lücke zwischen klinischer Verdachtsdiagnose auf der einen Seite und immunhistochemischen sowie molekularbiologischen Ergebnissen auf der anderen Seite zu schließen, um für diese Patienten ein europaweit einheitliches Konzept zur essenziellen Diagnostik und Behandlung zu formulieren. Nur dies schafft die Grundlagen für nationale sowie internationale Register und doppelblind randomisierte Therapiestudien zur ätiologisch differenzierten Behandlung der Myokarditis, die aufgrund zahlreicher Untersuchungen in den letzten Jahren Erfolg versprechen könnten. Im vorliegenden Beitrag zweier Mitglieder der Expertenarbeitsgruppe werden die wichtigsten Aspekte aus diesem im Juli 2013 im European Heart Joumal erschienen Positionspapier zu Ätiologie, Diagnose, Management und Therapie der Myokarditis zusammengefasst.

Abstract

Despite great advances in the pathophysiology and etiology of myocarditis, the clinical diagnosis of myocarditis in daily clinical practise remains challenging. Often the diagnosis was not clear because of the heterogeneity of clinical symptoms and the lack of guidelines for adequate diagnostic requirements and consecutive treatment options. The European Society of Cardiology (ESC) Working Group on Myocardial and Pericardial Diseases established a working group of experts to improve the diagnosis and management of myocarditis and to provide a common consensus statement as a reference for future registries and controlled trials. The goal was to bridge the gap between clinical- and tissue-based diagnosis by formulating a concept concerning essential diagnostics and treatment of these patients that would be accepted across Europe. Only in this manner is it possible to establish a basis for national and international registries and double-blind randomized treatment trials for the etiologically differentiated treatment of myocarditis, which appear promising due to numerous studies in recent years. In this paper, two members from the expert working group summarize the most important aspects of this position paper on the etiology, diagnosis, management, and treatment of myocarditis, which were published in the July 2013 issue of European Heart Joumal.

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Einhaltung ethischer Richtlinien

Interessenkonflikt. S. Pankuweit und B. Maisch geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine Studien an Menschen oder Tieren.

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Authors and Affiliations

  1. Klinik für Innere Medizin - Kardiologie, Philipps-Universität Marburg, Baldingerstr., 35043, Marburg, Deutschland

    S. Pankuweit PhD

  2. Fachbereich Medizin, Philipps-Universität, Marburg, Deutschland

    B. Maisch

  3. Herz- und Gefäßzentrum Marburg (HGZ), Marburg, Deutschland

    B. Maisch

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  1. S. Pankuweit PhD
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Correspondence to S. Pankuweit PhD.

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Pankuweit, S., Maisch, B. Ätiologie, Diagnose, Management und Therapie der Myokarditis. Herz 38, 855–861 (2013). https://doi.org/10.1007/s00059-013-3988-7

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