Mark H. Drazner, Biykem Bozkurt, Leslie T. Cooper, Niti R. Aggarwal, Cristina Basso, Nicole M. Bhave, Alida L.P. Caforio, Vanessa M. Ferreira, Bettina Heidecker, Amy R. Kontorovich, Pilar Martín, Gregory A. Roth, Jennifer E. Van Eyk
{"title":"2024 ACC Expert Consensus Decision Pathway on Strategies and Criteria for the Diagnosis and Management of Myocarditis: A Report of the American College of Cardiology Solution Set Oversight Committee","authors":"Mark H. Drazner, Biykem Bozkurt, Leslie T. Cooper, Niti R. Aggarwal, Cristina Basso, Nicole M. Bhave, Alida L.P. Caforio, Vanessa M. Ferreira, Bettina Heidecker, Amy R. Kontorovich, Pilar Martín, Gregory A. Roth, Jennifer E. Van Eyk","doi":"10.1016/j.jacc.2024.10.080","DOIUrl":null,"url":null,"abstract":"<h2>Section snippets</h2><section><section><h2>Solution Set Oversight Committee</h2>Nicole M. Bhave, MD, FACC, <em>Chair</em>Niti R. Aggarwal, MD, FACCKatie Bates, ARNP, DNPJohn P. Erwin <span>iii</span>, MD, FACCMartha Gulati, MD, MS, FACCDharam J. Kumbhani, MD, SM, FACCGurusher S. Panjrath, MBBS, FACCBarbara Wiggins, PharmD, FACCMegan Coylewright, MD, MPH, FACC, <em>Ex Officio</em></section></section><section><section><h2>Table of Contents</h2><ul><li><span></span><span>Top 10 Key Takeaway Points<!-- --> <!-- -->3</span></li><li><span>1.</span><span>Introduction<!-- --> <!-- -->4</span></li><li><span>2.</span><span>Assumptions and Proposed Definitions<!-- --> <!-- -->4<ul><li><span>2.1.</span><span>General Clinical Assumptions<!-- --> <!-- -->4</span></li><li><span>2.2.</span><span>Definitions<!-- --> <!-- -->5</span></li></ul></span></li><li><span>3.</span><span>Pathway Summary Graphic<!-- --> <!-- -->5<ul><li><span></span><span>Figure 1. The Evaluation and Management of Clinically Suspected Myocarditis Described as a 5-Step Care Pathway<!-- --> <!-- -->6</span></li></ul></span></li><li><span>4.</span><span>Description, Rationale, and Implication of Pathway<!-- --> <!-- -->7<ul><li><span>4.1.</span><span>Diagnosis of Myocarditis<!-- --> <!-- -->7<ul><li><span>4.1.1.</span><span>Clinical Symptoms<!-- --> <!-- -->7<ul><li><span></span><span>Figure 2. Three Classic Presentations of Myocarditis<!-- --> <!-- -->8</span></li></ul></span></li></ul></span></li><li><span>4.2.</span><span>Diagnostic Testing<!-- --> <!-- -->7<ul><li><span>4.2.1.</span><span>Electrocardiogram<!-- --> <!-- -->7</span></li><li><span>4.2.2.</span><span>Echo and Strain Echocardiography<!-- --> <!-- -->7</span></li><li><span>4.2.3.</span><span>Circulating Cardiac Troponin<!-- --> <!-- -->7</span></li><li><span>4.2.4.</span><span></span></li></ul></span></li></ul></span></li></ul></section></section><section><section><h2>Top 10 Key Takeaway Points</h2><ul><li><span>1.</span><span>Clinicians need to be aware of the 3 classic presentations of myocarditis: chest pain, heart failure (HF)/shock, and/or symptoms related to arrhythmia (eg, presyncope or syncope). In a young person, the history of an antecedent viral infection, or other risk factors that define stage A at-risk for myocarditis, followed by any of these cardiovascular symptoms should raise the suspicion of this diagnosis.</span></li><li><span>2.</span><span>High-sensitivity cardiac troponin (hs-cTn) is a common diagnostic test in patients with</span></li></ul></section></section><section><section><section><h2>General Clinical Assumptions</h2><ul><li><span>1.</span><span>The principal focus of this ECDP is on adults with acute myocarditis. For information on myocarditis in the pediatric population, the reader is referred to the “2021 AHA Scientific Statement on Diagnosis and Management of Myocarditis in Children.”<sup>1</sup> This ECDP does not address conditions with chronic inflammatory infiltrates of the myocardium, as this was considered beyond the scope of the paper.</span></li><li><span>2.</span><span>The writing committee endorses the evidence-based approach to HF and cardiomyopathy diagnosis and</span></li></ul></section></section></section><section><section><h2>Pathway Summary Graphic</h2>Figure 1 provides a summary graphic outlining the 5-step process for evaluation and management of clinically suspected myocarditis. The initial step is to recognize that a patient's clinical presentation might be consistent with the diagnosis of myocarditis. Given the numerous ways that myocarditis can manifest (Figure 2 and Section 4.1.1), clinicians in a variety of healthcare settings need to be aware of this diagnosis. Examples include primary care physicians; rheumatologists; oncologists;</section></section><section><section><h2>Description, Rationale, and Implication of Pathway</h2>Based upon a comprehensive literature review and expert opinion, this ECDP aims to inform clinicians regarding the following: 1) the current diagnostic algorithm to follow in the setting of suspected myocarditis; 2) the pivotal role of advanced imaging and EMB in the confirmation of myocarditis; 3) when to refer patients to an advanced HF center and potential therapies for those with advanced myocarditis; 4) a new 4-stage classification of myocarditis, now including those “at-risk” for</section></section><section><section><h2>President and Staff</h2>Cathleen Biga, MSN, FACC, PresidentCathleen C. Gates, Chief Executive OfficerRichard J. Kovacs, MD, MACC, Chief Medical OfficerBrendan Mullen, Senior Executive Vice PresidentJoseph M. Allen, MA, Team Leader, Science & QualityAmy Dearborn, Team Leader, Decision ScienceAshleigh M. Covington, MA, Team Lead, Decision Science DeliveryAlan Shinkar, MPH, Project Manager, Decision Science DeliveryGrace D. Ronan, Senior Production and Operations Manager, Clinical Policy Publication</section></section>","PeriodicalId":17187,"journal":{"name":"Journal of the American College of Cardiology","volume":"19 1","pages":""},"PeriodicalIF":21.7000,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of the American College of Cardiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.jacc.2024.10.080","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
章节片段解决方案集监督委员会主席尼科尔-M. 巴韦(Nicole M. Bhave)医学博士、FACC尼蒂-R. 阿加瓦尔(Niti R. Aggarwal)医学博士、FACC卡蒂-贝茨(Katie Bates)助理护士(ARNP)、DNP约翰-P. 埃尔温(John P. Erwin)医学博士、FACCM玛莎-古拉蒂(Martha Gulati)医学博士、医学硕士、FACCDharam J. Kumbhani(医学博士、医学硕士、FACC古鲁舍-S.Panjrath, MBBS, FACCBarbara Wiggins, PharmD, FACCMegan Coylewright, MD, MPH, FACC, Ex Officio目录十大要点31.引言42.假设和拟议定义42.1.一般临床假设42.2.定义53.路径摘要图5图 1.临床疑似心肌炎的评估和管理描述为 5 步护理路径 64.路径的描述、原理和含义 74.1.心肌炎的诊断 74.1.1.临床症状 7图 2.74.2.1.心电图 74.2.2.回波和应变超声心动图 74.2.3.循环心肌钙蛋白 74.2.4.十大要点1.临床医生需要了解心肌炎的三种典型表现:胸痛、心力衰竭(HF)/休克和/或心律失常相关症状(如晕厥前或晕厥)。一般临床假设1.本 ECDP 主要针对急性心肌炎成人患者。有关儿童心肌炎的信息,请读者参阅 "2021 年美国心脏协会关于儿童心肌炎诊断和管理的科学声明 "1。本 ECDP 不涉及心肌慢性炎症浸润的情况,因为这超出了本文的范围。第一步是认识到患者的临床表现可能符合心肌炎的诊断。鉴于心肌炎有多种表现形式(图 2 和第 4.1.1 节),各种医疗机构的临床医生都需要了解这一诊断。基于全面的文献综述和专家意见,本 ECDP 旨在向临床医生介绍以下内容:1) 怀疑患有心肌炎时应遵循的现行诊断算法;2) 高级成像和 EMB 在确认心肌炎中的关键作用;3) 何时将患者转诊至高级心房颤动中心,以及针对晚期心肌炎患者的潜在疗法;4) 新的心肌炎四阶段分类,现在包括那些有心肌炎 "风险 "的患者。Gates, 首席执行官Richard J. Kovacs, MD, MACC, 首席医疗官Brendan Mullen, 高级执行副总裁Joseph M. Allen, MA, Team Leader, Science & QualityAmy Dearborn, Team Leader, Decision ScienceAshleigh M. Covington, MA, Team Lead, Decision Science DeliveryAlan Shinkar, MPH, Project Manager, Decision Science DeliveryGrace D. Ronan, Senior Production and Operations Manager, Clinical Policy Publication
2024 ACC Expert Consensus Decision Pathway on Strategies and Criteria for the Diagnosis and Management of Myocarditis: A Report of the American College of Cardiology Solution Set Oversight Committee
Section snippets
Solution Set Oversight Committee
Nicole M. Bhave, MD, FACC, ChairNiti R. Aggarwal, MD, FACCKatie Bates, ARNP, DNPJohn P. Erwin iii, MD, FACCMartha Gulati, MD, MS, FACCDharam J. Kumbhani, MD, SM, FACCGurusher S. Panjrath, MBBS, FACCBarbara Wiggins, PharmD, FACCMegan Coylewright, MD, MPH, FACC, Ex Officio
Table of Contents
Top 10 Key Takeaway Points 3
1.Introduction 4
2.Assumptions and Proposed Definitions 4
2.1.General Clinical Assumptions 4
2.2.Definitions 5
3.Pathway Summary Graphic 5
Figure 1. The Evaluation and Management of Clinically Suspected Myocarditis Described as a 5-Step Care Pathway 6
4.Description, Rationale, and Implication of Pathway 7
4.1.Diagnosis of Myocarditis 7
4.1.1.Clinical Symptoms 7
Figure 2. Three Classic Presentations of Myocarditis 8
4.2.Diagnostic Testing 7
4.2.1.Electrocardiogram 7
4.2.2.Echo and Strain Echocardiography 7
4.2.3.Circulating Cardiac Troponin 7
4.2.4.
Top 10 Key Takeaway Points
1.Clinicians need to be aware of the 3 classic presentations of myocarditis: chest pain, heart failure (HF)/shock, and/or symptoms related to arrhythmia (eg, presyncope or syncope). In a young person, the history of an antecedent viral infection, or other risk factors that define stage A at-risk for myocarditis, followed by any of these cardiovascular symptoms should raise the suspicion of this diagnosis.
2.High-sensitivity cardiac troponin (hs-cTn) is a common diagnostic test in patients with
General Clinical Assumptions
1.The principal focus of this ECDP is on adults with acute myocarditis. For information on myocarditis in the pediatric population, the reader is referred to the “2021 AHA Scientific Statement on Diagnosis and Management of Myocarditis in Children.”1 This ECDP does not address conditions with chronic inflammatory infiltrates of the myocardium, as this was considered beyond the scope of the paper.
2.The writing committee endorses the evidence-based approach to HF and cardiomyopathy diagnosis and
Pathway Summary Graphic
Figure 1 provides a summary graphic outlining the 5-step process for evaluation and management of clinically suspected myocarditis. The initial step is to recognize that a patient's clinical presentation might be consistent with the diagnosis of myocarditis. Given the numerous ways that myocarditis can manifest (Figure 2 and Section 4.1.1), clinicians in a variety of healthcare settings need to be aware of this diagnosis. Examples include primary care physicians; rheumatologists; oncologists;
Description, Rationale, and Implication of Pathway
Based upon a comprehensive literature review and expert opinion, this ECDP aims to inform clinicians regarding the following: 1) the current diagnostic algorithm to follow in the setting of suspected myocarditis; 2) the pivotal role of advanced imaging and EMB in the confirmation of myocarditis; 3) when to refer patients to an advanced HF center and potential therapies for those with advanced myocarditis; 4) a new 4-stage classification of myocarditis, now including those “at-risk” for
President and Staff
Cathleen Biga, MSN, FACC, PresidentCathleen C. Gates, Chief Executive OfficerRichard J. Kovacs, MD, MACC, Chief Medical OfficerBrendan Mullen, Senior Executive Vice PresidentJoseph M. Allen, MA, Team Leader, Science & QualityAmy Dearborn, Team Leader, Decision ScienceAshleigh M. Covington, MA, Team Lead, Decision Science DeliveryAlan Shinkar, MPH, Project Manager, Decision Science DeliveryGrace D. Ronan, Senior Production and Operations Manager, Clinical Policy Publication
期刊介绍:
The Journal of the American College of Cardiology (JACC) publishes peer-reviewed articles highlighting all aspects of cardiovascular disease, including original clinical studies, experimental investigations with clear clinical relevance, state-of-the-art papers and viewpoints.
Content Profile:
-Original Investigations
-JACC State-of-the-Art Reviews
-JACC Review Topics of the Week
-Guidelines & Clinical Documents
-JACC Guideline Comparisons
-JACC Scientific Expert Panels
-Cardiovascular Medicine & Society
-Editorial Comments (accompanying every Original Investigation)
-Research Letters
-Fellows-in-Training/Early Career Professional Pages
-Editor’s Pages from the Editor-in-Chief or other invited thought leaders