Acute Myocarditis with Impaired LVEF: What to Do When Guideline-Directed Heart Failure Therapy Falls Short

A subset of patients with acute myocarditis develop significant left ventricular (LV) systolic dysfunction and heart failure that does not adequately respond to first-line guideline-directed management. When initial therapy fails to meet its goals, a defined next-line protocol is indicated.

Prior Treatment Line — Failure Condition

Goals not achieved

Previous therapy: Guideline-directed heart failure therapy in accordance with the ESC HF guidelines for myocarditis with LV systolic dysfunction and/or heart failure, continued for at least 6 months to support LV functional recovery.

Goals that were not met: Meaningful improvement in left ventricular function and sufficient reduction of heart failure symptoms. Failure to achieve these targets is the trigger for escalation to the next treatment line.

Next-Line Approach — Partial Overview

In acute myocarditis with impaired LVEF that remains refractory to standard heart failure therapy, the next step involves a corticosteroid-based strategy directed at stabilizing cardiac function. The complete protocol — including the specific approach, sequencing, and monitoring framework — is available in the structured regimen below.

Instant Access to Structured Evidence-Based Regimens

References

Corticosteroids may be considered in patients with acute myocarditis with impaired LVEF if refractory to standard HF therapy to stabilize patients.

DOI: 10.1093/eurheartj/ehaf192

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