Clozapine-induced myocarditis: “Psychoanalysing” drug-induced myocarditis
International Journal of Cardiology(2018)
摘要
Myocarditis is an inflammatory disorder of the heart. Its clinical presentation is diverse and can range from an asymptomatic episode to acute heart failure and sudden cardiac death. The prognosis is also highly variable and, depending on the aetiology, can cover a spectrum from complete healing without long-term sequelae to severe heart failure due to dilated cardiomyopathy requiring cardiac transplantation [ [1] Sagar S. Liu P.P. Cooper Jr., L.T. Myocarditis. Lancet. 2012; 379: 738-747 Abstract Full Text Full Text PDF PubMed Scopus (330) Google Scholar ]. The list of aetiological factors is long and can be roughly divided into infectious, immunological and toxic causes [ [2] Caforio A.L. Pankuweit S. Arbustini E. Basso C. Gimeno-Blanes J. Felix S.B. Fu M. Helio T. Heymans S. Jahns R. Klingel K. Linhart A. Maisch B. McKenna W. Mogensen J. Pinto Y.M. Ristic A. Schultheiss H.P. Seggewiss H. Tavazzi L. Thiene G. Yilmaz A. Charron P. Elliott P.M. M. European Society of Cardiology Working Group on, D. Pericardial Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur. Heart J. 2013; 34 (2648a–2648d): 2636-2648 Crossref PubMed Scopus (1188) Google Scholar ]. Diagnosis of myocarditis can be challenging and is based on high degree of clinical suspicion and a combination of clinical, biochemical and imaging investigations. Endomyocardial biopsy (EMB) is considered to be the “gold-standard” for the diagnosis of myocarditis and, although its use in experienced hands can diagnose myocarditis with high sensitivity and specificity, it is limited by potential complications but also ready access to expertise in performing and analysing the samples [ [3] Cooper L.T. Baughman K.L. Feldman A.M. Frustaci A. Jessup M. Kuhl U. Levine G.N. Narula J. Starling R.C. Towbin J. Virmani R. The role of endomyocardial biopsy in the management of cardiovascular disease: a scientific statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology. Endorsed by the Heart Failure Society of. J. Am. Coll. Cardiol. 2007; 50: 1914-1931 Crossref PubMed Scopus (422) Google Scholar ]. EMB aims to demonstrate histological evidence of myocyte injury and inflammatory infiltrate, but can also detect viral nucleic acid. Cardiac magnetic resonance imaging (MRI) is gaining popularity and improvement in its technology and development of newer sequences that can detect myocardial oedema and injury has led to significant improvement in the diagnostic rate of myocarditis [ [4] Lurz P. Luecke C. Eitel I. Fohrenbach F. Frank C. Grothoff M. de Waha S. Rommel K.P. Lurz J.A. Klingel K. Kandolf R. Schuler G. Thiele H. Gutberlet M. Comprehensive cardiac magnetic resonance imaging in patients with suspected myocarditis: The MyoRacer-Trial. J. Am. Coll. Cardiol. 2016; 67: 1800-1811 Crossref PubMed Scopus (203) Google Scholar ]. CMR is safe and also provides accurate assessments of myocardial function, but does not identify the nature of the inflammatory infiltrate or detect cause. A systematic review of clozapine-induced myocarditisInternational Journal of CardiologyVol. 259PreviewClozapine is an atypical antipsychotic that is beneficial to some patients who failed to have an adequate clinical response to other antipsychotic drugs. Its clinical use is limited due to several potentially fatal adverse reactions including myocarditis. Careful monitoring of patients on clozapine is required. Full-Text PDF
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关键词
myocarditis,clozapine-induced,drug-induced
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