Myocarditis, Cardiomyopathy and Cardiac Arrhythmias: Current Status and Future Directions

Dear Colleagues,

Cardiomyopathies, a heterogeneous group of diseases characterized by morphological and functional alterations of the myocardium, are an evolving concept for fundamental research and clinical practice. From an epidemiological point of view, cardiomyopathies represent an important cause of high morbidity and mortality due to heart failure, arrhythmias, and sudden death. Major advances have influenced their definition and taxonomy, but their classification is still complex and challenging based on an incomplete standardization. The impressive progress in the genetic testing of inherited cardiomyopathies has allowed the establishment of a dynamic interchangeable spectrum of dilation, hypertrophy, and restrictive patterns. Besides the last advances in next-generation sequencing, multimodality cardiac imaging techniques are the cornerstone of diagnosis and essential in assessing risk stratification to better target patient engagement strategies. Concurrent with diagnostic advances, novel opportunities and challenges for therapies have emerged. The primary genetic etiology of different cardiomyopathies has created a new paradigm for targeting treatments on the basis of the underlying molecular cause. Several clinical cardiomyopathy trials have addressed targeted therapies, including gene therapy, myofilament function, protein quality control, and metabolic changes. Such targets are being tested or are even already in use for hypertrophic cardiomyopathy, cardiac amyloidosis, or some forms of dilated cardiomyopathy. The field of therapeutic repositioning is also a fascinating area of clinical research and many efforts are being concentrated to ensure sustainable therapies.

Myocarditis represents another challenging field to be resolved since up to 20% of myocarditis patients may subsequently develop chronic inflammatory dilated cardiomyopathy. The report from the 2021 National Heart, Lung, and Blood Institute Workshop identified many key gaps but also opportunities in basic, diagnostic, translational, and therapeutic fields to guide future research in myocarditis. The COVID-19 pandemic highlighted its socio-economic impact along with the need for a deep understanding of myocarditis pathogenesis and for identifying new therapeutic targets. The nonspecific presentation of myocarditis is a major challenge for clinicians, and there is an urgent need to develop a multimodal approach including discriminatory immunological targets and cardiac imaging data but also for etiology-specific treatments.

Cardiac arrhythmias have a complex causal relationship with myocarditis and cardiomyopathies. They are often a consequence of developing heart failure, but also can cause left-ventricular systolic dysfunction such as arrhythmia-induced cardiomyopathy. This relationship should be considered by the physician treating a patient with systolic heart failure and cardiac arrhythmia. There is increasing evidence regarding the arrhythmias as the first presentation in genetic cardiomyopathies. For patients presenting with cardiomyopathy or arrhythmias, including frequent premature ventricular contractions, conduction system disease, early onset atrial fibrillation, or familial history of premature sudden death, genetic testing is warranted. This could be the basis for developing a personalized approach for screening, extending the indications for current therapeutic strategies, but also for changing the prognosis and further development of emerging targeted therapies.

In this Special Issue dedicated to “Myocarditis, Cardiomyopathies and Cardiac Arrhythmias”, we aim to focus on the latest advances in basic, translational, and clinical fields. The aim of this topic is to provide novel evidence of the genetic and molecular basis, the role of the multimodal diagnostic approach including biomarkers and cardiac imaging, the experimental and clinical results of novel therapies, along with new ideas in drug development and translational medicine. It is our pleasure to invite researchers and clinicians to submit their works to be published in this unique Special Issue of the Medicina journal, which is published by MDPI. We welcome papers that address this topic, in the form of original research articles, clinical trials, meta-analyses, and systematic reviews.

Dr. Viviana Onofrei
Dr. Ioana Cristina Daha
Dr. Ionut Tudorancea
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

• myocarditis
• genetic cardiomyopathies
• cardiac arrhythmias
• multimodal cardiac imaging
• experimental medicine
• clinical trials
• targeted novel therapies