Diagnostic algorithm for clozapine-induced myocarditis: A systematic review Article Swipe
Yassir Mahgoub
,
Rawan Alhau
,
Yumna Magzoub
,
Aya Ali
,
E A Nour
,
Mustafa Saeed
,
Sarajul Fikri Mohamed
,
Ali H. Hassan
,
Omaima Ali
·
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.5498/wjp.v15.i9.108525
YOU?
·
· 2025
· Open Access
·
· DOI: https://doi.org/10.5498/wjp.v15.i9.108525
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.
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All OpenAlex metadata
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https://doi.org/10.5498/wjp.v15.i9.108525Digital Object Identifier
- Title
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Diagnostic algorithm for clozapine-induced myocarditis: A systematic reviewWork title
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articleOpenAlex work type
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enPrimary language
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2025Year of publication
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2025-08-26Full publication date if available
- Authors
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Yassir Mahgoub, Rawan Alhau, Yumna Magzoub, Aya Ali, E A Nour, Mustafa Saeed, Sarajul Fikri Mohamed, Ali H. Hassan, Omaima AliList of authors in order
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https://doi.org/10.5498/wjp.v15.i9.108525Publisher landing page
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YesWhether a free full text is available
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diamondOpen access status per OpenAlex
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https://doi.org/10.5498/wjp.v15.i9.108525Direct OA link when available
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0Total citation count in OpenAlex
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56Number of works referenced by this work
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10Other works algorithmically related by OpenAlex
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| referenced_works | https://openalex.org/W2051001886, https://openalex.org/W2054776920, https://openalex.org/W2568509854, https://openalex.org/W4295199764, https://openalex.org/W2114974747, https://openalex.org/W4391637686, https://openalex.org/W2129428899, https://openalex.org/W1997185715, https://openalex.org/W1987473028, https://openalex.org/W2086862995, https://openalex.org/W2055006506, https://openalex.org/W2089260926, https://openalex.org/W2908039688, https://openalex.org/W4206933607, https://openalex.org/W2784142531, https://openalex.org/W1567867011, https://openalex.org/W3110701940, https://openalex.org/W2071278180, https://openalex.org/W2963109133, https://openalex.org/W2140921081, https://openalex.org/W2438920515, https://openalex.org/W3000096215, https://openalex.org/W2940809144, https://openalex.org/W2083501070, https://openalex.org/W2073569528, https://openalex.org/W4293776739, https://openalex.org/W1964994355, https://openalex.org/W3193598686, https://openalex.org/W2903759577, https://openalex.org/W3214498259, https://openalex.org/W2963818273, https://openalex.org/W4400520883, https://openalex.org/W2912495842, https://openalex.org/W2549349499, https://openalex.org/W3017190126, https://openalex.org/W2037055794, https://openalex.org/W3184929654, https://openalex.org/W4293213446, https://openalex.org/W2012545157, https://openalex.org/W3198078019, https://openalex.org/W2030863330, https://openalex.org/W2079887863, https://openalex.org/W1996879112, https://openalex.org/W2955522911, https://openalex.org/W3160333765, https://openalex.org/W3019144522, https://openalex.org/W3129384891, https://openalex.org/W3006699356, https://openalex.org/W2094801845, https://openalex.org/W2987741699, https://openalex.org/W3168375083, https://openalex.org/W2281475034, https://openalex.org/W4206654893, https://openalex.org/W3208707565, https://openalex.org/W4405649425, https://openalex.org/W2979032524 |
| referenced_works_count | 56 |
| abstract_inverted_index.A | 56, 142, 163 |
| abstract_inverted_index.a | 39, 85 |
| abstract_inverted_index.To | 37 |
| abstract_inverted_index.Up | 133 |
| abstract_inverted_index.an | 160 |
| abstract_inverted_index.as | 159 |
| abstract_inverted_index.in | 71, 120, 130 |
| abstract_inverted_index.is | 8, 115 |
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| abstract_inverted_index.on | 87, 98 |
| abstract_inverted_index.to | 11, 31, 44, 122, 134, 149 |
| abstract_inverted_index.119 | 60 |
| abstract_inverted_index.136 | 125 |
| abstract_inverted_index.65% | 135 |
| abstract_inverted_index.AIM | 36 |
| abstract_inverted_index.CIM | 43, 79, 95, 138, 155, 175 |
| abstract_inverted_index.CIP | 185 |
| abstract_inverted_index.CMR | 153 |
| abstract_inverted_index.The | 76 |
| abstract_inverted_index.and | 19, 22, 33, 50, 66, 81, 90, 100, 104, 109, 152, 172, 186 |
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| abstract_inverted_index.the | 2, 23, 182 |
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| abstract_inverted_index.1990 | 65 |
| abstract_inverted_index.2.9% | 128 |
| abstract_inverted_index.CIM. | 190 |
| abstract_inverted_index.CIM; | 180 |
| abstract_inverted_index.CIP, | 49 |
| abstract_inverted_index.CMR, | 171 |
| abstract_inverted_index.Slow | 177 |
| abstract_inverted_index.dose | 183 |
| abstract_inverted_index.from | 48 |
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| abstract_inverted_index.lack | 140 |
| abstract_inverted_index.lead | 30 |
| abstract_inverted_index.like | 13 |
| abstract_inverted_index.safe | 52 |
| abstract_inverted_index.with | 26, 73, 84, 92, 127, 157 |
| abstract_inverted_index.(CIP) | 29 |
| abstract_inverted_index.(CMR) | 114 |
| abstract_inverted_index.2025) | 68 |
| abstract_inverted_index.64.7% | 121 |
| abstract_inverted_index.68.9% | 123 |
| abstract_inverted_index.April | 67 |
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| abstract_inverted_index.cases | 139 |
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| abstract_inverted_index.fatal | 131 |
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| abstract_inverted_index.guide | 51 |
| abstract_inverted_index.risks | 12 |
| abstract_inverted_index.(CIM). | 16 |
| abstract_inverted_index.PRISMA | 74 |
| abstract_inverted_index.PubMed | 61 |
| abstract_inverted_index.adjust | 181 |
| abstract_inverted_index.cases, | 126 |
| abstract_inverted_index.relies | 97 |
| abstract_inverted_index.review | 58, 77 |
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| abstract_inverted_index.enhance | 45 |
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| abstract_inverted_index.imaging, | 21, 89 |
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| abstract_inverted_index.proposed | 143 |
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| abstract_inverted_index.confirmed | 189 |
| abstract_inverted_index.diagnosis | 80, 96 |
| abstract_inverted_index.involving | 165 |
| abstract_inverted_index.outcomes, | 83 |
| abstract_inverted_index.outcomes. | 132 |
| abstract_inverted_index.pneumonia | 28, 151 |
| abstract_inverted_index.premature | 34 |
| abstract_inverted_index.resistant | 6 |
| abstract_inverted_index.resonance | 112 |
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| abstract_inverted_index.titration | 178 |
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| abstract_inverted_index.C-reactive | 101 |
| abstract_inverted_index.CONCLUSION | 162 |
| abstract_inverted_index.Clozapine, | 1 |
| abstract_inverted_index.accordance | 72 |
| abstract_inverted_index.biomarkers | 18 |
| abstract_inverted_index.cardiology | 173 |
| abstract_inverted_index.diagnosis. | 176 |
| abstract_inverted_index.diagnostic | 40 |
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| abstract_inverted_index.successful | 119 |
| abstract_inverted_index.systematic | 57 |
| abstract_inverted_index.tomography | 148 |
| abstract_inverted_index.underused. | 116 |
| abstract_inverted_index.Rechallenge | 117 |
| abstract_inverted_index.biomarkers, | 88 |
| abstract_inverted_index.cardiology. | 93 |
| abstract_inverted_index.discontinue | 187 |
| abstract_inverted_index.guidelines. | 75 |
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| abstract_inverted_index.rechallenge | 82 |
| abstract_inverted_index.significant | 24 |
| abstract_inverted_index.tomography, | 170 |
| abstract_inverted_index.Non-specific | 17 |
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| abstract_inverted_index.rechallenge. | 54 |
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| abstract_inverted_index.confirmation. | 141 |
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| abstract_inverted_index.inconsistently | 107 |
| abstract_inverted_index.schizophrenia, | 7 |
| abstract_inverted_index.discontinuation. | 35 |
| abstract_inverted_index.echocardiography | 105, 158 |
| abstract_inverted_index.clozapine-induced | 14, 27 |
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| citation_normalized_percentile.is_in_top_10_percent | False |