BACKGROUND Clozapine,the gold standard for resistant schizophrenia,is underused due to risks like clozapine-induced myocarditis(CIM).Non-specific biomarkers and inconsistent imaging,and the significant overlap with cl...BACKGROUND Clozapine,the gold standard for resistant schizophrenia,is underused due to risks like clozapine-induced myocarditis(CIM).Non-specific biomarkers and inconsistent imaging,and the significant overlap with clozapine-induced pneumonia(CIP)lead to misdiagnosis and premature discontinuation.AIM To develop a diagnostic algorithm for CIM to enhance accuracy,differentiate from CIP,and guide safe clozapine rechallenge.METHODS A systematic review of 119 PubMed studies(published between 1990 and April 2025)was conducted in accordance with PRISMA guidelines.The review analyzed CIM diagnosis and rechallenge outcomes,with a focus on biomarkers,imaging,and collaboration with cardiology.RESULTS CIM diagnosis relies on troponin and C-reactive protein;electrocardiography and echocardiography are inconsistently applied,and cardiac magnetic resonance imaging(CMR)is underused.Rechallenge was successful in 64.7%to 68.9%of 136 cases,with 2.9%resulting in fatal outcomes.Up to 65%of presumed CIM cases lack confirmation.A proposed protocol integrates chest computed tomography to exclude pneumonia and CMR for CIM confirmation,with echocardiography as an alternative.CONCLUSION A protocol involving multidisciplinary collaboration among computed tomography,CMR,and cardiology improves CIM diagnosis.Slow titration prevents CIM;adjust the dose for CIP and discontinue for confirmed CIM.展开更多
文摘BACKGROUND Clozapine,the gold standard for resistant schizophrenia,is underused due to risks like clozapine-induced myocarditis(CIM).Non-specific biomarkers and inconsistent imaging,and the significant overlap with clozapine-induced pneumonia(CIP)lead to misdiagnosis and premature discontinuation.AIM To develop a diagnostic algorithm for CIM to enhance accuracy,differentiate from CIP,and guide safe clozapine rechallenge.METHODS A systematic review of 119 PubMed studies(published between 1990 and April 2025)was conducted in accordance with PRISMA guidelines.The review analyzed CIM diagnosis and rechallenge outcomes,with a focus on biomarkers,imaging,and collaboration with cardiology.RESULTS CIM diagnosis relies on troponin and C-reactive protein;electrocardiography and echocardiography are inconsistently applied,and cardiac magnetic resonance imaging(CMR)is underused.Rechallenge was successful in 64.7%to 68.9%of 136 cases,with 2.9%resulting in fatal outcomes.Up to 65%of presumed CIM cases lack confirmation.A proposed protocol integrates chest computed tomography to exclude pneumonia and CMR for CIM confirmation,with echocardiography as an alternative.CONCLUSION A protocol involving multidisciplinary collaboration among computed tomography,CMR,and cardiology improves CIM diagnosis.Slow titration prevents CIM;adjust the dose for CIP and discontinue for confirmed CIM.
