Recent Advances in Multimodal Diagnosis and Precision Management of Myocarditis

Myocarditis is an inflammatory disease of the myocardium caused by infectious, autoimmune, or toxic triggers; meanwhile, myocarditis remains a persistent clinical challenge due to the heterogeneous nature and often nonspecific presentation of myocarditis. Recent advances in cardiac magnetic resonance (CMR), particularly quantitative tissue characterization techniques, together with improvements in molecular diagnostic methods, have substantially strengthened the accuracy of noninvasive diagnosis. Concurrently, management strategies are increasingly shifting toward etiology-directed approaches, including targeted immunomodulatory therapies combined with optimized supportive care, thereby contributing to improved clinical outcomes. This review summarizes key developments in myocarditis over the past five years, with a focus on progress in multimodal diagnostic evaluation and precision management. We first outline current perspectives on etiology and clinical phenotypes, then examine the complementary roles of quantitative CMR imaging and endomyocardial biopsy in diagnostic decision-making. Recent advances in the management of major clinical subtypes, including viral myocarditis, immune checkpoint inhibitor-associated myocarditis, giant cell myocarditis, and pediatric myocarditis, are then discussed. Indeed, by integrating emerging clinical evidence, we highlight the evolving diagnostic and therapeutic framework, identify remaining challenges, and propose future directions to improve risk stratification and individualized patient care.