Inflammatory cardiomyopathy and myocarditis: current evidence and plans for the future

Author(s): Richter Dennert

Inflammatory cardiomyopathy is mostly caused by viruses, but it can also be caused by infections caused by bacteria, protozoa, or fungal organisms, a wide range of drugs and toxic substances, and systemic immune-mediated diseases. A poor prognosis is associated with inflammatory cardiomyopathy that is complicated by left ventricular dysfunction, heart failure, or arrhythmia, despite extensive research. It is currently unknown why some patients recover without any residual damage to their myocardium while others develop dilated cardiomyopathy. It is still up for debate to determine which viruses are active inducers and which are merely bystanders in disease progression and healing, as well as the relative roles of the pathogen, host genomics, and environmental factors. Consequently, there is a lack of well-established treatment options. With a special focus on virus-induced and virus-associated myocarditis, we summarize and evaluate the evidence on the pathogenesis, diagnosis, and treatment of myocarditis and inflammatory cardiomyopathy in this Review. In addition, we identify knowledge gaps, evaluate the experimental models that are available, and suggest future directions for the field. The cardiovascular effects of severe acute respiratory syndrome coronavirus infection are also discussed, along with any unanswered questions.