Table 1

Brighton collaboration criteria for myocarditis

Level 1: ‘definitive’ caseLevel 2: ‘probable case’Level 3: ‘possible case’
Histopathologic examination of myocardial tissue (autopsy or endomyocardial biopsy) showed myocardial inflammation
≥1 new finding of
  • Troponin T or I level above upper limit of normal

≥1 New cMRI findings consistent with
  • Oedema on T2-weighted study, typically patchy in nature

  • Late gadolinium enhancement on T1-weighted study with an increased enhancement ratio between myocardial and skeletal muscle typically involving at least one non-ischaemic regional distribution with recovery (myocyte injury)

Echocardiogram (ECHO) abnormalities biomarkers ≥1 new finding of as per level 2 case
Clinical symptoms and exclusion as per Level three case
Elevated myocardial biomarkers ≥1 new finding of
  • Troponin T level above upper limit of normal

  • Troponin I level above upper limit of normal

  • CK myocardial band

Echocardiogram (ECHO) abnormalities ≥1 new finding of
  • Focal or diffuse left or right ventricular function abnormalities (eg, decreased ejection fraction)

  • Segmental wall motion abnormalities

  • Global systolic or diastolic function depression/abnormality

  • Ventricular dilation

  • Wall thickness change

  • Intracavitary thrombi

ECG abnormalities≥1 new finding of
  • Paroxysmal or sustained atrial or ventricular arrhythmias (premature atrial or ventricular beats, and/or supraventricular or ventricular tachycardia, interventricular conduction delay, abnormal Q waves, low voltages)

  • AV nodal conduction delays or intraventricular conduction defects (atrioventricular block (grade I–III), new bundle branch block)

  • Continuous ambulatory electrocardiographic monitoring that detects frequent atrial or ventricular ectopy

Presence of ≥1 new or worsening of the following clinical symptoms:
  • Chest pain/pressure

  • Dyspnoea/shortness of breath/pain breathing

  • Diaphoresis

  • Palpitations

  • Sudden death

Presence of ≥2 new or worsening of the following clinical symptoms:
  • Fatigue

  • Abdominal Pain

  • Syncope

  • Oedema

  • Cough

≥1 new supported finding of inflammation
Elevated CRP/ESR or D-Dimer
Presence of ≥1 new abnormal ECG such as:
  • ST-segment or T-wave abnormalities (elevation or inversion)

  • PACs and PVCs

  • No other identifiable cause of the symptoms and findings

  • AV, atrioventricular; cMRI, cardiac MRI; PAC, premature atrial complex; PVC, premature ventricular complex.