Background Myocarditis and pericarditis are inflammatory cardiac diseases with heterogeneous clinical presentations, ranging from mild to life-threatening conditions, and occur more frequently in young adult males. Purpose and Methods This observational study included adult patients with cardiac magnetic resonance (CMR)-confirmed myocarditis admitted to a high-volume cardiology center between March 2017 and July 2025. The aim was to evaluate in-hospital management and mid- to long-term follow-up in accordance with the 2020 ANMCO/SIC protocol and the 2025 ESC Guidelines for the management of myocarditis and pericarditis. Results Seventy patients were enrolled (mean age 34 years, 87% male). Infarct-like chest pain was the predominant presentation (97%). Initial suspicion was myocarditis or myopericarditis in 68.6%, while 27.1% were initially managed as acute coronary syndrome, including STEMI and NSTEMI, with normal coronary angiography. Most patients were classified as intermediate risk (84.3%), 14.3% as low risk, and one as high risk with fulminant myocarditis. ST-segment elevation was observed in 41.4%, and reduced LVEF (<55%) in 18.6%. CMR detected late gadolinium enhancement (LGE) in 98.6% of patients, involving ≥2 segments in 72.9%. At discharge, 60 patients were diagnosed with myocarditis and 10 with myopericarditis. At six-month follow-up, residual LV dysfunction was rare (2.9%), while LGE persisted in most cases, though with reduced extension. Holter monitoring and stress testing were largely normal. During follow-up, one recurrence occurred at one year and five at three years; genetic testing identified a pathogenic variant in one recurrent case. Conclusions In a non-transplant cardiology center, myocarditis patients predominantly exhibited low- to intermediate-risk profiles and favorable outcomes. These findings support the real-world applicability of the 2025 ESC guideline recommendations.
Associazione Nazionale Medici Cardiologi Ospedalieri
