Diagnostic algorithm for clozapine-induced myocarditis: A systematic review.

IF 3.4 4区医学 Q1 PSYCHIATRY

World Journal of Psychiatry Pub Date : 2025-09-19 DOI:10.5498/wjp.v15.i9.108525

Yassir Mahgoub, Rawan Alhau, Yumna Magzoub, Aya Ali, Eptihal Nour, Mustafa E E Saeed, Sameera G M Mohamed, Ahmed O S Hassan, Omaima Ali

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引用次数: 0

Abstract

Background: Clozapine, the gold standard for resistant schizophrenia, is underused due to risks like clozapine-induced myocarditis (CIM). Non-specific biomarkers and inconsistent imaging, and the significant overlap with clozapine-induced pneumonia (CIP) lead to misdiagnosis and premature discontinuation.

Aim: To develop a diagnostic algorithm for CIM to enhance accuracy, differentiate from CIP, and guide safe clozapine rechallenge.

Methods: A systematic review of 119 PubMed studies (published between 1990 and April 2025) was conducted in accordance with PRISMA guidelines. The review analyzed CIM diagnosis and rechallenge outcomes, with a focus on biomarkers, imaging, and collaboration with cardiology.

Results: CIM diagnosis relies on troponin and C-reactive protein; electrocardiography and echocardiography are inconsistently applied, and cardiac magnetic resonance imaging (CMR) is underused. Rechallenge was successful in 64.7% to 68.9% of 136 cases, with 2.9% resulting in fatal outcomes. Up to 65% of presumed CIM cases lack confirmation. A proposed protocol integrates chest computed tomography to exclude pneumonia and CMR for CIM confirmation, with echocardiography as an alternative.

Conclusion: A protocol involving multidisciplinary collaboration among computed tomography, CMR, and cardiology improves CIM diagnosis. Slow titration prevents CIM; adjust the dose for CIP and discontinue for confirmed CIM.

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氯氮平性心肌炎的诊断算法：系统综述。

背景：氯氮平是治疗难治性精神分裂症的金标准，但由于氯氮平诱发的心肌炎（CIM）等风险，其使用不足。非特异性生物标志物和不一致的成像，以及与氯氮平诱导的肺炎（CIP）的显著重叠导致误诊和过早停药。目的：建立CIM的诊断算法，提高CIM的准确性，与CIP区分，指导氯氮平的安全再挑战。方法：根据PRISMA指南对119篇PubMed研究（发表于1990年至2025年4月）进行系统评价。该综述分析了CIM的诊断和再挑战结果，重点是生物标志物、成像和与心脏病学的合作。结果：CIM诊断依赖于肌钙蛋白和c反应蛋白；心电图和超声心动图的应用不一致，心脏磁共振成像（CMR）未得到充分利用。136例患者中，再挑战成功率为64.7% ~ 68.9%，死亡率为2.9%。多达65%的假定CIM病例缺乏确认。一项建议的方案将胸部计算机断层扫描排除肺炎和CMR进行CIM确认，超声心动图作为替代方案。结论：一个涉及计算机断层扫描、CMR和心脏病学多学科合作的方案可以提高CIM的诊断。缓慢滴定防止CIM；调整CIP的剂量，并停止已确认的CIM。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

World Journal of Psychiatry PSYCHIATRY-

自引率

6.50%

发文量

110

期刊介绍： The World Journal of Psychiatry (WJP) is a high-quality, peer reviewed, open-access journal. The primary task of WJP is to rapidly publish high-quality original articles, reviews, editorials, and case reports in the field of psychiatry. In order to promote productive academic communication, the peer review process for the WJP is transparent; to this end, all published manuscripts are accompanied by the anonymized reviewers’ comments as well as the authors’ responses. The primary aims of the WJP are to improve diagnostic, therapeutic and preventive modalities and the skills of clinicians and to guide clinical practice in psychiatry.