LAUSR

This article refers to ‘Predictors of relapse, death or heart transplantation in myocarditis before the introduc-tion of immunosuppression: negative prognostic impact of female gender, fulminant onset, lower ejection fraction and serum autoantibodies’ by A. Baritussio et al. , pub-lished in this issue on pages 1 033– 1 044. The best management and long-term impact of myocarditis remain controversial partly because of the breadth of aetiologies and outcomes reported from relatively small clinical studies. Prospectively gathered, large and well-characterized myocarditis case series are needed to fill the gaps in this knowledge base and inform treatment strategies. In this context, the study by Baritussio et al. 1 in this issue of the Journal provides new and valuable insights into the mechanisms, risk of recurrence and management of acute myocarditis. Their series 466 acute myocarditis patients with an average duration of symptoms of less than 1 day from a large aca-demic referral centre. The diagnosis relied on standardized histological examination of heart tissue and validated imaging findings on cardiac magnetic resonance (CMR) in combination with clinical symptoms. The strengths of their study design include blind-ing of CMR readers to clinical data, prospective blood and tissue collection, and standardized outcome assessment methods. Their most impactful observations include the association of female sex, heart failure requiring inotropic or mechanical circulatory support, and higher autoantibodies titres with a greater risk of death or heart transplantation. Myocarditis recurrence, a rarely measured occurred in 1 8% of subjects and associated with myocarditis