p.10 抽出テキスト

It is introduced as an entering diagnostic term to lead to a tailored workup and individualized therapy. Patient-oriented case management is proposed in different settings such as diagnosis and therapy, as well as return to work and play avoiding strict time definitions, since the remission pathway differs from patient to patient. In addition, a novelty in the field of IMPS is the improved knowledge on its possible genetic background and its link to specific inherited CMPs. Furthermore, a paradigm shift will be introduced in its diagnostic management. This is reflecting the new capabilities of multimodality imaging, especially CMR, as it has changed clinical workflow during recent years. A similar change was introduced in the American College of Cardiology (ACC) consensus statement in 2024.9 Endomyocardial biopsy has its place and is needed if specific decisions are warranted. In comparison with the last ESC Guidelines for the diagnosis and management of pericardial diseases,1 the current understanding of the pathogenesis of pericarditis has greatly improved with new evidence on the importance of the interplay between inflammation and autoinflammatory mechanisms, the role of genetic background, and immune responses in patients with multiple recurrences. The identification of a positive family history, a poor response to colchicine, and a clinical presentation with an inflammatory or non-inflammatory phenotype are useful tools to guide the selection of patients for genetic testing and specific pharmacological options. A new class of drugs targeting interleukin-1 (IL-1), the so-called anti-IL-1 agents, has become available and is used in recurrent cases with a poor response to other conventional therapies. Nevertheless, we need to further improve our understanding of the pathogenesis of non-inflammatory disease forms.

Moreover, diagnostic capabilities have increased, thanks to the role of multimodality imaging, allowing improved diagnostic accuracy and

 

 

	





	

   


 
	

 


 	

Figure 2 Paradigm change in the clinical diagnosis of myocarditis. CMR, cardiovascular magnetic resonance; EMB, endomyocardial biopsy. Both EMB and CMR can provide a definitive clinical diagnosis but with different indications. Details are given in Section 5. 2013 Reference: Caforio et al.10 2021 and 2023 References: Keren et al., Law et al.6,14

ESC Guidelines                                                                                                                                                                                          3961

Downloaded from academic.oup.com/eurheartj/article/46/40/3952/8234483 by guest on 07 October 2026