Diagnostic and therapeutic recommendations for steroid-resistant myocarditis
| Guidelines | ||||
| ESMO (2022)1 | ASCO (2021)3 | SITC (2021)2 | NCCN (2023)40 | |
| Diagnostic procedures | ||||
| Blood analysis (troponin, creatine kinase/-MB, N-terminal pro-B-type natriuretic peptide/brain natriuretic peptide) | ✓ | ✓ | ✓ | ✓ |
| ECG | ✓ | ✓ | ✓ | ✓ |
| Echocardiography | ✓ | ✓ | ✓ | ✓ |
| Cardiac Imaging: Cardiac MRI, cardiac Ga-DOTATOC, FDG-PET-CT | ✓ | ✓ | ✓ | ✓ |
| Endomyocardial biopsy (endovascular) | ✓ | ✓ | ✓ | ✓ |
| Cardiac stress testing or heart catheterization | ✓ | ✓ | ||
| Chest X-ray | ✓ | |||
| Consultation with a cardiologist | ✓ | ✓ | ✓ | ✓ |
| Treatment options (1) First choice of additional immunosuppressive treatment. (2) Other options of immunosuppressive treatment. (*) No treatment sequence mentioned. | ||||
| Infliximab (intravenous) | ✓(1) | ✓(*) | ||
| Mycophenolate mofetil (peroral) | ✓(1) | ✓(1) | ✓(*) | ✓(*) |
| Anti-thymocyte globulin (intravenous) | ✓(2) | ✓(1) | ✓(*) | ✓(*) |
| Abatacept (intravenous) | ✓(2) | ✓(2) | ✓(*) | ✓(*) |
| Alemtuzumab (intravenous) | ✓(2) | ✓(2) | ✓(*) | ✓(*) |
| Tocilizumab (intravenous) | ✓(1) | |||
| Immunoglobulin (intravenous) | ✓(*) | |||
ASCO, American Society of Clinical Oncology ; creatine kinase-MB, heart specific isoenzyme of creatine kinase; ESMO, European Society for Medical Oncology ; FDG-PET, Fluorodeoxyglucose-Positron Emission Tomography; Ga-DOTATOC, Gallium-based ligand binding to somatostatin receptors; NCCN, National Comprehensive Cancer Network ; SITC, Society for Immunotherapy of Cancer.