Myocarditis and inflammatory cardiomyopathy: current evidence and future directions

Carsten Tschöpe, Enrico Ammirati, Biykem Bozkurt, Alida L.P. Caforio, Leslie T. Cooper, Stephan B. Felix, Joshua M. Hare, Bettina Heidecker, Stephane Heymans, Norbert Hübner, Sebastian Kelle, Karin Klingel, Henrike Maatz, Abdul S. Parwani, Frank Spillmann, Randall C. Starling, Hiroyuki Tsutsui, Petar Seferovic, Sophie Van Linthout

Research output: Contribution to journalReview articlepeer-review

566 Citations (Scopus)


Inflammatory cardiomyopathy, characterized by inflammatory cell infiltration into the myocardium and a high risk of deteriorating cardiac function, has a heterogeneous aetiology. Inflammatory cardiomyopathy is predominantly mediated by viral infection, but can also be induced by bacterial, protozoal or fungal infections as well as a wide variety of toxic substances and drugs and systemic immune-mediated diseases. Despite extensive research, inflammatory cardiomyopathy complicated by left ventricular dysfunction, heart failure or arrhythmia is associated with a poor prognosis. At present, the reason why some patients recover without residual myocardial injury whereas others develop dilated cardiomyopathy is unclear. The relative roles of the pathogen, host genomics and environmental factors in disease progression and healing are still under discussion, including which viruses are active inducers and which are only bystanders. As a consequence, treatment strategies are not well established. In this Review, we summarize and evaluate the available evidence on the pathogenesis, diagnosis and treatment of myocarditis and inflammatory cardiomyopathy, with a special focus on virus-induced and virus-associated myocarditis. Furthermore, we identify knowledge gaps, appraise the available experimental models and propose future directions for the field. The current knowledge and open questions regarding the cardiovascular effects associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are also discussed. This Review is the result of scientific cooperation of members of the Heart Failure Association of the ESC, the Heart Failure Society of America and the Japanese Heart Failure Society.

Original languageEnglish
Pages (from-to)169-193
Number of pages25
JournalNature Reviews Cardiology
Issue number3
Publication statusPublished - Mar 2021

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine


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