Adapting the 2025 European Society of Cardiology Myocarditis and Pericarditis Guidelines for Asia: Applying Global Standards to Regional Realities

Failure VIEWPOINTThe eagerly awaited 2025 European Society of Cardiology (ESC) guidelines for the management of myocarditis and pericarditis consolidate these conditions within a unified framework of inflammatory myopericardial syndromes (IMPS) to highlight the spectrum of disease and provide streamlined diagnostic algorithms that expedite diagnosis and treatment.1 The guidelines emphasise multimodal imaging, including an expanded role for cardiac MRI, and a more selective approach to endomyocardial biopsy.They advocate multidisciplinary team management, particularly in fulminant myocarditis with cardiogenic shock, and highlight the use of interleukin (IL-1) inhibitors for recurrent drug-refractory or steroiddependent pericarditis.For many Asian countries, these guidelines are both timely and necessary, given the projected rise in incidence and mortality associated with myocarditis and pericarditis over the next few decades.2,3 However, their translation into measurable clinical impact will require thoughtful adaptation to the region's epidemiological patterns, and varying healthcare resource availability regarding advanced diagnostics and targeted anti-inflammatory therapies.Addressing these contextual challenges will be pivotal to implementing the IMPS-based framework effectively across Asia's diverse healthcare systems. Mechanical Circulatory Support in Fulminant MyocarditisThe ESC guidelines emphasise a multidisciplinary, shock-team approach for rapid decision-making in patients with fulminant myocarditis and cardiogenic shock, including timely initiation of mechanical circulatory support (MCS).