p.8 抽出テキスト
The writing and reviewing panels provide declaration of interest forms for all relationships that might be perceived as real or potential sources of conflicts of interest. Their declarations of interest are reviewed according to the ESC declaration of interest rules, which can be found on the ESC website (http://www.escardio.org/doi) and are compiled in a report published in a supplementary document with the guidelines. Funding for the development of ESC Guidelines is derived entirely from the ESC with no involvement of the healthcare industry. The CPG Committee supervises and co-ordinates the preparation of new guidelines and approves their publication. In addition to review by the CPG Committee, ESC Guidelines undergo multiple rounds of double-blind peer review on a dedicated online review platform. The review is conducted by topic experts, including members from ESC National Cardiac Societies and from relevant ESC Subspecialty Communities. Guideline Task Forces consider all review comments and are required to respond to all those classified as major. After appropriate revisions, the Task Force and the CPG Committee members approve the final document for publication in the European Heart Journal. Unless otherwise stated, ESC Guidelines content refers to sex, understood as the biological condition of being male or female, defined by genes, hormones and sexual organs. Off-label use of medication may be presented in this guideline if a sufficient level of evidence shows that it can be considered medically appropriate for a given condition. However, decisions on off-label use must be made by the responsible health professional giving special consideration to ethical rules concerning healthcare, the specific situation of the patient, patient consent, and country-specific health regulations.
2 Introduction
Myocarditis and pericarditis are inflammatory diseases of the myocardium and pericardium, respectively, with potential overlap. These are the first ESC clinical practice guidelines covering the whole spectrum of these diseases. Herein, the Task Force (TF) introduces the term ‘inflammatory myopericardial syndrome’ (IMPS). IMPS is an umbrella term during the initial diagnostic process until a final diagnosis is made (Figure 1). It reflects the possible myocarditis–pericarditis overlap, aiming to increase the awareness of the spectrum of disease, and to allow timely diagnosis and better management. IMPS ranges from isolated myocarditis to isolated pericarditis through mixed forms with possible reciprocal involvement, such as myopericarditis and perimyocarditis. Both terms are commonly used in the medical literature, and defined in the 2015 ESC Guidelines for the diagnosis and management of pericardial diseases (see Section 8).1
The rationale for the introduction of IMPS is that myocarditis and pericarditis have similar aetiologies and are anatomical contiguous structures with possible secondary involvement.2–5 The field has experienced rapid growth, with position statements proposed by different cardiac societies.6–10 In the past, several consensus statements were provided, usually defining a proven myocarditis based on endomyocardial biopsy (EMB). Endomyocardial biopsy is able to detect the histological type, can identify some specific aetiologies, and can help to differentiate from non-inflammatory cardiomyopathies (CMPs).10 But nowadays multimodality imaging has become a cornerstone for the diagnosis of myocardial and pericardial inflammation and cardiovascular magnetic resonance (CMR) plays a crucial role, as reported in other ESC guidelines11–13 (Figure 2). The aim of these guidelines is to provide evidence-based guidance for clinical management of IMPS, to guide clinicians of all subspecialties from a clinical point of view, and to ensure qualified shared decisionmaking with patients (see Section 13 and Supplementary data online, Section 8).
2.1 What is new
Guidelines on pericarditis have been published twice before,1,15 while myocarditis will be covered for the first time in a guideline. The TF believes that combined guidelines with the recognition of the spectrum of disease are a step in a new direction, enabling a paradigm shift towards therapy based on the combined input from experts in inflammatory diseases of the myocardium and pericardium, with the support of a multidisciplinary team. In order to improve the awareness of the spectrum of disease, a new category, ‘inflammatory myopericardial syndrome (IMPS)’, will be introduced as an umbrella term to increase the understanding of the potential myocarditis–pericarditis overlap.
Table 2 Levels of evidence
©
ESC Guidelines 3959
Downloaded from academic.oup.com/eurheartj/article/46/40/3952/8234483 by guest on 07 October 2026
