{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T23:36:23Z","timestamp":1787960183643,"version":"build-2784847793"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,4,21]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">Desmosomal \u201chot\u2010phase\u201d cardiomyopathy (HPC), characterized by bursts of myocardial inflammation mimicking acute myocarditis (AM), carries relevant risks of adverse outcomes. This study aimed to identify diagnostic \u201cred flags\u201d favoring HPC over AM.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">Patients (n=134) receiving a first diagnosis of AM, proven by endomyocardial biopsy or cardiac magnetic resonance plus troponin elevation, were retrospectively identified at a referral center. HPC was defined by presence of pathogenic desmosomal gene variants (DGVs). Clinical, imaging, and electrical features were compared between HPC cases and controls with gene\u2010negative AM to identify red flags. Diagnostic algorithms were derived and tested in an external multicenter cohort of DGV carriers (n=30).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Patients with HPC (n=22; 91%\n                      <jats:italic toggle=\"no\">DSP<\/jats:italic>\n                      +) were more frequently female (73% versus 24%,\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      &lt;0.001) and younger than unmatched controls with AM (32\u00b114 versus 41\u00b114\u2009years,\n                      <jats:italic toggle=\"no\">P<\/jats:italic>\n                      =0.007). When matched 1:1 by age, sex, and presentation, DGV carriers showed distinctive red flags: family history of cardiomyopathy\/AM\/sudden death; recurrent troponin peaks; persistent left ventricular systolic dysfunction; right ventricular involvement; ring\u2010like late gadolinium enhancement; late gadolinium enhancement persistence or extension; low QRS voltages; life\u2010threatening ventricular arrhythmias at &lt;45\u2009years; persistent &gt;1000\/24\u2009hours ventricular ectopy; and recurrent nonsustained ventricular tachycardia. A \u201cfirst\u2010contact\u201d algorithm based on female sex and age &lt;30\u2009years achieved 77% accuracy, identifying 63% of DGV carriers in the external cohort. An alternative algorithm incorporating ring\u2010like late gadolinium enhancement, right ventricular involvement, and family history showed higher accuracy (93%) and yield (93%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">Myocarditis in DGV carriers predominantly affects young women. A red flag\u2010based approach improves recognition of desmosomal HPC over classic AM.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.044887","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T10:06:54Z","timestamp":1775556414000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Red Flags for Differentiating Desmosomal \u201cHot\u2010Phase\u201d Cardiomyopathy From Acute Myocarditis"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1815-4000","authenticated-orcid":false,"given":"Giovanni","family":"Peretto","sequence":"first","affiliation":[{"name":"IRCCS San Raffaele Scientific Institute","place":["Milan, Italy"]},{"name":"IRCCS San Raffaele Scientific Institute","place":["Milan, Italy"]},{"name":"Vita\u2010Salute San Raffaele University","place":["Milan, 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