Diagnostic algorithm for clozapine-induced myocarditis: A systematic review

Table 2 Summarizes studies on clozapine rechallenges after presumptive diagnosis of myocarditis

Ref.	Study type	Sample size	Rechallenge success rate	Fatal failure	Diagnostic certainty	Confirmatory test used	Key findings	Limitations
Richardson et al[57], 2021	Systematic review	88 cases from 88 case reports/case series	64.7%	2.9%	Low (4.5% biopsy-confirmed)	Biopsy (4.5%) No CMR	High failure rate, rare fatalities	Based on the case report, we rely on biomarkers for diagnosis, with no exclusion of overlapping conditions
McMahon et al[58], 2024	Systematic review	45 cases	68.9%	0%	Moderate (EKG/TEE in < 33%)	EKG, TEE (< 33%)	No fatalities, 1/3 failed	Based on case reports
						No CMR		Most of the studies diagnosed myocarditis based on biomarkers alone
								With no workup overlapping conditions
Noël et al[59], 2019	Case series	3 cases	33.3%	0%	High (EKG/TEE evidence)	EKG, TEE	Success is only in mild cases	Case series

CMR: Cardiac magnetic resonance; EKG: Electrocardiogram; TEE: Traneosophageal echocardiography.