Трансформація поглядів на визначення, класифікацію та діагностику міокардиту

The medical community’s historical conceptual changes in perception of myocarditis are presented in the work. Changes from the pathological to the clinical diagnosis of «myocarditis», and attitudes towards the classification of myocarditis are being discussed. A new stage classification (stages A, B, C and D) and a step-by-step algorithm for myocarditis diagnosis according to the Report of the American College of Cardiology (2024) are presented. Changes in the priorities and informative value of various instrumental diagnostic methods are also discussed. Thus, the experts of the American College of Cardiology, unlike the specialists of the European Working Group, attributed selective coronary angiography to first-line examinations. Changes in the assessment of endomyocardial heart biopsies using the «Dallas Criteria» and the «Marburg Consensus» are shown. Changes of gadolinium-enhanced cardiac magnetic resonance imaging role are also discussed. The updated Lake Louise criteria (2018) have significantly increased the sensitivity (up to 87.5 %) and specificity (up to 96.2 %) of this method. So today, cardiac magnetic resonance imaging is considered a diagnostic test of choice in clinical scenarios with uncomplicated myocarditis and often allows for noninvasive diagnosis of stages B and C in patients with myocarditis. Endomyocardial biopsy of the heart has been shown to be justified in patients with complicated myocarditis (with reduced left ventricular ejection function, symptomatic heart failure, or electrical instability), and for the diagnosis of specific conditions that require etiologically directed therapy, including immune suppressive agents.