Lymphocytic myocarditis: A histopathologic definition and classification from the Society for Cardiovascular Pathology and Association for European Cardiovascular Pathology. I: Endomyocardial biopsy

IF 1.9 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Pathology Pub Date : 2025-07-23 DOI:10.1016/j.carpath.2025.107759

Marc K. Halushka , Giulia d’Amati , Melanie C. Bois , John T. Fallon , Carla Giordano , Karin Klingel , Charles Leduc , Richard N. Mitchell , Stefania Rizzo , Cristina Basso

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Abstract

Background and aim

Lymphocytic myocarditis has long been appreciated as a lymphocyte-predominant myocardial inflammation with resultant myocyte injury. However, current methods of diagnosis on endomyocardial biopsy (EMB) lead to inconsistent diagnoses. To improve patient care, the criteria for the diagnosis of lymphocytic myocarditis on endomyocardial biopsies have been revised to address shortcomings of the Dallas Criteria and European Society of Cardiology (ESC) criteria.

Methods and results

In the Seaport area of Boston, a panel of expert cardiovascular pathologists from the Society for Cardiovascular Pathology (SCVP) and the Association for European Cardiovascular Pathology (AECVP) completed a three-year project to develop consensus terms and definitions. These “Seaport” criteria for EMB were developed to utilize CD3 immunohistochemistry for T lymphocytes and accurately define each level of histopathologic severity based on extent of infiltrate and presence of myocyte injury. These criteria create a diagnostic approach to lymphocytic myocarditis using three grades of severity (mild, moderate, and severe) along with a category of scattered increased T lymphocytes of undetermined significance (SITUS). The document discusses the role of ancillary studies, the relationship to other diagnostic modalities, and areas of continuing controversy in the development of these criteria.

Conclusion

These consensus-based criteria offer a standardized framework for diagnosing lymphocytic myocarditis in EMB. Adoption of these easy-to-use criteria will improve classification of lymphocytic myocarditis as an aid to diagnose and treat patients.

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淋巴细胞性心肌炎：来自心血管病理学会和欧洲心血管病理协会的组织病理学定义和分类。I：心内膜肌活检。

背景和目的：淋巴细胞性心肌炎长期以来被认为是一种以淋巴细胞为主的心肌炎症，导致心肌细胞损伤。然而，目前的诊断方法的心内膜肌活检（EMB）导致不一致的诊断。为了改善患者的护理，为了解决达拉斯标准和欧洲心脏病学会（ESC）标准的不足，对心内膜肌活检诊断淋巴细胞性心肌炎的标准进行了修订。方法和结果：在波士顿的海港地区，来自心血管病理学学会（SCVP）和欧洲心血管病理学协会（AECVP）的心血管病理学专家小组完成了一项为期三年的项目，以制定共识的术语和定义。这些EMB的“海港”标准是利用T淋巴细胞的CD3免疫组织化学，并根据浸润程度和肌细胞损伤的存在准确地定义每个组织病理严重程度。这些标准创建了一种淋巴细胞性心肌炎的诊断方法，使用三个严重等级（轻度、中度和重度）以及一类不确定意义的分散增加的T淋巴细胞（SITUS）。该文件讨论了辅助研究的作用，与其他诊断模式的关系，以及在这些标准的发展中持续存在争议的领域。结论：这些基于共识的标准为EMB淋巴细胞性心肌炎的诊断提供了一个标准化的框架。采用这些易于使用的标准将提高淋巴细胞性心肌炎的分类，有助于患者的诊断和治疗。

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来源期刊

Cardiovascular Pathology 医学-病理学

CiteScore

7.50

自引率

2.70%

发文量

审稿时长

18 days

期刊介绍： Cardiovascular Pathology is a bimonthly journal that presents articles on topics covering the entire spectrum of cardiovascular disease. The Journal''s primary objective is to publish papers on disease-oriented morphology and pathogenesis from clinicians and scientists in the cardiovascular field. Subjects covered include cardiovascular biology, prosthetic devices, molecular biology and experimental models of cardiovascular disease.