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Review Article | DOI: https://doi.org/10.31579/2641-0419/507
1Heart Institute of the Ministry of Health of Ukraine.
2National Scientific Center "Institute of Cardiology, Clinical and Regenerative Medicine named after Academician M.D. National Academy of Medical Sciences of Ukraine.
*Corresponding Author: V. Riabenko, National Scientific Center
Citation: O.V. Onyshchenko, D.V. Riabenko, O.A. Yepanchintseva, (2025), Diagnosis, Definition and Classification of Myocarditis. Isn't it time to Start Thinking about Changing?, J Clinical Cardiology and Cardiovascular Interventions, 8(13); DOI:10.31579/2641-0419/507
Copyright: © 2025, D.V. Riabenko. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Received: 12 August 2025 | Accepted: 08 September 2025 | Published: 19 September 2025
Keywords: myocarditis; definition; classification; endomyocardial biopsy; gadolinium-enhanced cardiac magnetic resonance
The paper presents historical changes in the understanding of myocarditis by the medical community. Changes in the priorities and informative value of instrumental methods such as endomyocardial biopsy and gadolinium-enhanced cardiac magnetic resonance imaging in myocarditis are shown.
Changes in the diagnosis and classification of myocarditis are presented. The new staging classification (stages A, B, C and D) according to the American College of Cardiology report (2024) is presented. Changes to the definition and classification of myocarditis are also being proposed for discussion.
Myocarditis is an enigmatic condition that continues to elude comprehensive understanding; posing numerous unanswered questions.
The study of this pathology was initiated in the latter half of the seventeenth century; with the seminal work of the renowned French physician Jean-Baptiste Sénac in Traité de la structure du cœur; de son action et de ses maladies (1749) marking a pivotal moment. This seminal work provided the first fundamental description of inflammatory heart disease and the challenges associated with its diagnosis. Subsequently; in 1806; the founder of clinical cardiology; Professor Jean-Nicolas Corvisart; advanced the hypothesis that the root of pathogenic infection lies in the body's inherent variability; and the human organism is inherently vulnerable to succumbing to ailments that pose a threat to its well-being (Karamanou et al.; 2010). And in 1873; J. F. Sobernheim was the first coiner of the term "myocarditis" (Pandey et al.; 2023).
Since that time; there has been a considerable advancement in the field; with the diagnostic process for this disease evolving from a post-mortem examination to a clinical and instrumental lifetime diagnosis.
The present-day diagnosis of the condition is based on the presence of clinical manifestations (e.g. chest pain; heart rhythm and conduction disturbances; symptoms of heart failure (HF)) that can be interpreted as manifestations of myocarditis. Changes in the results of non-invasive and laboratory tests of the "first line" (e.g. electrocardiogram; echocardiogram; inflammatory markers [e.g. the erythrocyte sedimentation rate (ESR); CRP]; levels of highly sensitive cardiac-specific troponins (cTn) I or T; levels of brain natriuretic peptides [BNP]; serum cardiac autoantibodies) may also be indicative of myocarditis (Caforio et al.; 2013).
The primary instrumental methodologies employed for the establishment (confirmation) of a diagnosis of myocarditis encompass magnetic resonance imaging (MRI) with gadolinium and endomyocardial biopsy (EMB).
Endomyocardial biopsy.
The development of this method was a major turning point in the study of myocarditis. It made it possible for the first time to diagnose of myocarditis during life. In the late 20th century; Japanese researchers S. Sakakibara and S. Konno published studies demonstrating the feasibility of using a flexible bioptome and performing endomyocardial sampling (EMB) with forceps (Sakakibara & Konno; 1962).
Further modifications of the bioptome (Stanford Caves-Shulz bioptome) by P.K. Caves et al. (1973) rendered it feasible to perform percutaneous biopsies through the right internal jugular vein with only local anaesthesia. This development subsequently became a standard device for EBM for a period of approximately two decades.
In 1987; the “Dallas criteria” were developed by a group of leading American morphologists (Aretz et al.; 1987). They were the first (and for a long time the main) method of myocarditis identifying and developed a histopathological classification of the disease (Aretz et al.; 1987).
In 1995; the Working Group of the World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of Cardiomyopathies among other sources; identified a group of "specific cardiomyopathies"; which included inflammatory cardiomyopathy and myocarditis (Richardson et al.; 1996). The term “inflammatory cardiomyopathy” was defined as myocarditis in combination with cardiac dysfunction. Myocarditis was interpreted as an inflammatory myocardial disease; and it was diagnosed using established histological; immunological and immunohistochemical criteria (Richardson et al.; 1996).
The "Dallas criteria" were in use for almost a 10-year period. However; it was subsequently determined that these histological criteria exhibited high specificity but low sensitivity. L.H. Chow et al. (1989) found that only 25% of autopsy specimens showed histologic signs of myocarditis; and only 10% of patients with HF "de novo" met these criteria (Chow et al.; 1989; Baughman; 2006).
In 1997; two committees of experts were convened for the purpose of formulating a consensus on the definition of myocarditis; which was referred to as the "Marburg Consensus" (WHF Classification and Consensus Conference; 1997). The Committee defined myocarditis as a process characterized by an inflammatory myocardial infiltrate; the extent of which was to be determined by immunohistochemical examination (WHF Classification and Consensus Conference; 1997).
This Consensus states that the diagnosis of myocarditis should be confirmed when at least 14 infiltrated leukocytes/mm² are detected; predominantly T lymphocytes (CD45RO) or activated T cells (e.g.; CD45RO). This total cell count could also include up to 4 macrophages and 7 cells/mm² or more CD3-positive T lymphocytes (WHF Classification and Consensus Conference; 1997).
It was also recommended that the amount and distribution of fibrosis be taken into account. The classification system employed in this study categorized fibrosis as follows: grade 0; no fibrosis; grade 1; mild fibrosis; grade 2; moderate fibrosis; and grade 3; severe fibrosis. The localization or formation of fibrosis was to be described as endocardial; replacement; or interstitial. The process was considered to be reparative if focal or diffuse leukocytes were localized in fibrotic areas (WHF Classification and Consensus Conference; 1997).
According to the results obtained from the initial biopsy; the following findings were made (WHF Classification and Consensus Conference; 1997):
The inflammatory infiltrate should be classified as lymphocytic; eosinophilic; neutrophilic; giant cell; granulomatous; or mixed. The distribution should be classified as focal; confluent; or diffuse; respectively.
The EMB method has evolved quite rapidly and; as a result of the integration of histological; immunohistochemical and molecular analysis; has been established as the "gold standard" for the definitive diagnosis of myocarditis (Thiene et al.; 2013).
Subsequent to the publication of the joint American Heart Association (AHA) and European Society of Cardiology (ESC) guidelines on the role of EMB in cardiovascular disease in 2007; this method has been employed in tertiary care centers worldwide (Cooper et al.; 2007; Cooper; 2024).
In 2013; the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases published a Position Statement; which represented the first attempt to provide specific diagnostic criteria and recommendations for the treatment of myocarditis (Caforio et al.; 2013). The statement summarised current knowledge of the aetiology; pathogenesis; and diagnosis of myocarditis; and attempted to provide standardised definitions for use in future registries and clinical trials on the subject.
The Statement asserted that the EMB should be considered the "gold standard" for accurate diagnosis of myocarditis. The EMB is capable of verifying a diagnosis of myocarditis; in addition to establishing the fundamental cause of the inflammation and identifying the specific inflammation type (e.g.; giant cell; eosinophilic myocarditis; sarcoidosis). This information enables the determination of different treatment methods and the prediction of patient prognosis. Simultaneously; it was emphasized that this method is not a standard procedure. It was further noted that not all patients with suspected myocarditis should undergo EMB (Caforio et al.; 2013).
Over the past 10-15 years; there have been significant conceptual changes in the medical community's understanding of the etiopathogenesis; interpretation; classification; and approaches to the treatment of myocarditis. This paradigm change was the result of a substantial number of clinical and experimental studies; as well as the integration of a diverse array of immunological; molecular biological and non-invasive research methodologies into clinical practice. At the same time; the views on the role of EMB in diagnosing the disease also changed (Ammirati et al; 2020). This was “facilitated” by a significant number of false-negative EMB results due to tissue biopsy errors; especially in moderate and focal inflammatory infiltrates. Thus; A.J. Hauck et al. (1989) showed that usually 4 to 6 biopsy samples are taken during the diagnostic procedure. However; a thorough postmortem analysis of confirmed cases of myocarditis showed that for the correct diagnosis of myocarditis in more than 80% of cases; 17 samples or more are required. It is evident that this number of biopsies cannot be performed in clinical practice; thereby underscoring the deficiency in EMB sensitivity. Moreover; the ESC Task Force (2023) emphasized the necessity of employing experienced teams to perform EMB; and that diagnostic biopsy processing should be conducted exclusively by pathologists with experience working with cardiomyopathies (Arbelo et al.; 2023). Therefore; it was suggested to use (reserve) EMB with quantifying inflammatory cells using immunohistochemistry and the identification of viral genomes only for specific cases. This approach is recommended when the potential benefits of EMB outweigh any potential risks and it results can influence treatment (Arbelo et al.; 2023; Parrillo; 2001; Vidusa et al.; 2022; Dominguez et al.; 2016).
According to some experts; this method with the use immunohistochemical methods (IHC) and polymerase chain reaction (PCR) can be considered the "gold standard" for final diagnosis in patients with fulminant course (i.e.; suspicion of giant cell or eosinophilic myocarditis; vasculitis or sarcoidosis) or lack of response to empiric treatment (Vidusa et al.; 2022; Dominguez et al.; 2016).
In the 2024 American College of Cardiology Report (ACC Expert Consensus Decision Pathway on Strategies and Criteria for the Diagnosis and Management of Myocarditis); the use of EMB is also recommended in individual cases to confirm specific types of myocarditis; including giant cell; eosinophilic; and sarcoidosis (Drazner et al.; 2024). It is emphasised that the evaluation of EMB samples should be performed using IHC counting of inflammatory cells and the use of PCR and reverse transcription of mRNA to DNA (PCR-RT). IHC and molecular biological analysis of EMB help identify the cause of myocarditis and determine which patients need specific therapy (Drazner et al.; 2024).
This is applicable to patients suffering from myocarditis complicated by; for example; decreased ventricular function; symptomatic heart failure; hemodynamic or electrical instability (Drazner et al.; 2024).
At the same time; the place of various methods for the detection of inflammation in the myocardium in routine clinical practice is still under discussion.
Among other non-invasive imaging techniques; cardiac MRI with contrast has become increasingly important in the diagnosis of myocarditis.
Magnetic resonance imaging (MRI) with gadolinium.
Since the late 1990s; MRI has been extensively used for the diagnosis of myocarditis. The initial publication by M.G. Gagliardi et al. (1991) on T2-weighted MRI results in children with myocarditis was published; and the first controlled clinical trial with contrast enhancement was conducted in 1998 (Friedrich et al.; 1998). Since that time; a significant number of studies have been carried out to demonstrate the diagnostic usefulness of contrast-free and contrast-enhanced MRI in patients with myocarditis (Laissy et al.; 2002; Abdel-Aty et al.; 2005; Gutberlet et al.; 2008; Roditi & Hartnell; 2000; Laissy et al.; 2005; De Cobelli et al.; 2006; Friedrich et al.; 2009).
Contrast-enhanced MRI provides significant insights into the analysis of myocardial morphology and function. This advancement can also be attributed to the replacement of the 2009 Lake Louise criteria with the updated 2018 criteria (Ferreira et al.; 2018; Joudar et al.; 2023).
These updated Lake Louise Criteria (2018) for non-ischemic myocardial inflammation use T1/T2 mapping (in order to obtain signal values of the myocardium itself) and extracellular volume (ECV) (Ferreira et al.; 2018). Myocardial fibrosis/edema may be assessed by T1 mapping (Class I recommendation; Level of Evidence: B); and myocardial edema may be evaluated using T2 mapping or T2-weighted imaging (Class I recommendation; Level of Evidence: B) (Nagai et al.; 2023). According to these Criteria (2018); the diagnosis of an inflammatory process requires the presence of at least one T2-based criterion (global or regional increased myocardial T2 relaxation time or increased signal intensity on T2-weighted images) in addition to one T1-based criterion (increased myocardial T1; LGE or ECV) (Ferreira et al.; 2018).
The use of the updated Lake Louise Criteria (2018) resulted in an enhancement of the method's sensitivity to 87.5% and its specificity to 96.2% (Joudar et al.; 2023). In the ACC Expert Consensus (2024); cardiac MRI using the updated Lake Louise criteria (2018) is classified as a Class I recommendation for stable patients; regardless of myocarditis etiology (Drazner et al.; 2024). MRI provides non-invasive multi-parametric characterisation of myocardial tissue and is the gold standard imaging test for the assessment of cardiac structure and function.
Myocardial changes observed in myocarditis include myocardial edema (intracellular and interstitial); hyperemia; increased vascular permeability or capillary leakage; myocyte injury and necrosis; and the formation of interstitial and/or focal fibrosis and pericardial inflammation or effusion (Drazner et al.; 2024).
This method is especially important for detecting inflammation in the epicardial and middle regions of the myocardium; which is characteristic of acute myocarditis and cannot be diagnosed by EMB (Cooper; 2024). Furthermore; the results of the MRI scan permitted the control of the prognosis (Tschöpe et al.; 2021).
Therefore; it's now believed that cardiac MRI with enhancement should be used not only to diagnose myocarditis in haemodynamically stable patients (class I recommendation; level of evidence A); but also to assess myocardial pathology; risk stratification (class I recommendation; level of evidence B) and evaluation of therapy effectiveness (Nagai et al.; 2023).
Cardiac MRI with enhancement has the highest sensitivity (>85%) and efficacy when performed within the first 1-2 weeks of symptom onset; when edema/inflammation are present (Joudar et al.; 2023; Nagai et al.; 2023; Tschöpe et al.; 2021; Luetkens et al.; 2019; Pan et al.; 2018).
In addition; American experts have recommended a new staging classification and step-by-step algorithm for the diagnosis of acute myocarditis. The proposed staging of myocarditis includes (Drazner et al.; 2024):
For general clinical practice; distinguishing between stages A and B is particularly important. Stage A not only reminds doctors to take preventive measures against this disease; but also encourages them to monitor patients who have recovered from myocarditis.
Stage B (asymptomatic myocarditis); on the other hand; allows diagnosis and treatment in the early stages of the disease; increasing the chances that the myocarditis will be uncomplicated and speeding up the recovery of such patients.
Thus; taking into account the conceptual changes in the view of myocarditis and the role of instrumental diagnostic methods of this disease; some revision of the definition and classification of myocarditis is relevant. We propose to discuss the possibility of using the following definition of myocarditis.
Myocarditis is a group of multifactorial inflammatory diseases of the heart muscle characterized by the presence of inflammation and/or non-ischemic damage to heart muscle cells (degeneration and necrosis of adjacent heart muscle cells).
The term "non-ischemic" cardiomyocyte damage is used because these manifestations are one of the MRI criteria for the diagnosis of acute myocarditis and are very common in infarct-like; giant cell and eosinophilic types of myocarditis.
We also propose the following classification of myocarditis. Myocarditis may be:
I. According to aetiology:
II. By the extent of the inflammatory process (according to MRI and/or EMB):
III. The morphological characteristics of the infiltrate (according to the data from the EMB):
IV. According to the course:
V.According to the severity of the symptoms and the type of disease:
We believe that such changes in the definition and classification of the "myocarditis" disease group will not only help to improve diagnostic approaches; but also allow for more differentiated treatment of such patients.
The authors declare no conflicts of interest regarding the publication of this paper.
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To Dear Erin Aust, I would like to express my heartfelt appreciation for the opportunity to have my work published in this esteemed journal. The entire publication process was smooth and well-organized, and I am extremely satisfied with the final result. The Editorial Team demonstrated the utmost professionalism, providing prompt and insightful feedback throughout the review process. Their clear communication and constructive suggestions were invaluable in enhancing my manuscript, and their meticulous attention to detail and dedication to quality are truly commendable. Additionally, the support from the Editorial Office was exceptional. From the initial submission to the final publication, I was guided through every step of the process with great care and professionalism. The team's responsiveness and assistance made the entire experience both easy and stress-free. I am also deeply impressed by the quality and reputation of the journal. It is an honor to have my research featured in such a respected publication, and I am confident that it will make a meaningful contribution to the field.
"I am grateful for the opportunity of contributing to [International Journal of Clinical Case Reports and Reviews] and for the rigorous review process that enhances the quality of research published in your esteemed journal. I sincerely appreciate the time and effort of your team who have dedicatedly helped me in improvising changes and modifying my manuscript. The insightful comments and constructive feedback provided have been invaluable in refining and strengthening my work".
I thank the ‘Journal of Clinical Research and Reports’ for accepting this article for publication. This is a rigorously peer reviewed journal which is on all major global scientific data bases. I note the review process was prompt, thorough and professionally critical. It gave us an insight into a number of important scientific/statistical issues. The review prompted us to review the relevant literature again and look at the limitations of the study. The peer reviewers were open, clear in the instructions and the editorial team was very prompt in their communication. This journal certainly publishes quality research articles. I would recommend the journal for any future publications.
Dear Jessica Magne, with gratitude for the joint work. Fast process of receiving and processing the submitted scientific materials in “Clinical Cardiology and Cardiovascular Interventions”. High level of competence of the editors with clear and correct recommendations and ideas for enriching the article.
We found the peer review process quick and positive in its input. The support from the editorial officer has been very agile, always with the intention of improving the article and taking into account our subsequent corrections.
My article, titled 'No Way Out of the Smartphone Epidemic Without Considering the Insights of Brain Research,' has been republished in the International Journal of Clinical Case Reports and Reviews. The review process was seamless and professional, with the editors being both friendly and supportive. I am deeply grateful for their efforts.
To Dear Erin Aust – Editorial Coordinator of Journal of General Medicine and Clinical Practice! I declare that I am absolutely satisfied with your work carried out with great competence in following the manuscript during the various stages from its receipt, during the revision process to the final acceptance for publication. Thank Prof. Elvira Farina
Dear Jessica, and the super professional team of the ‘Clinical Cardiology and Cardiovascular Interventions’ I am sincerely grateful to the coordinated work of the journal team for the no problem with the submission of my manuscript: “Cardiometabolic Disorders in A Pregnant Woman with Severe Preeclampsia on the Background of Morbid Obesity (Case Report).” The review process by 5 experts was fast, and the comments were professional, which made it more specific and academic, and the process of publication and presentation of the article was excellent. I recommend that my colleagues publish articles in this journal, and I am interested in further scientific cooperation. Sincerely and best wishes, Dr. Oleg Golyanovskiy.
Dear Ashley Rosa, Editorial Coordinator of the journal - Psychology and Mental Health Care. " The process of obtaining publication of my article in the Psychology and Mental Health Journal was positive in all areas. The peer review process resulted in a number of valuable comments, the editorial process was collaborative and timely, and the quality of this journal has been quickly noticed, resulting in alternative journals contacting me to publish with them." Warm regards, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. I appreciate the journal (JCCI) editorial office support, the entire team leads were always ready to help, not only on technical front but also on thorough process. Also, I should thank dear reviewers’ attention to detail and creative approach to teach me and bring new insights by their comments. Surely, more discussions and introduction of other hemodynamic devices would provide better prevention and management of shock states. Your efforts and dedication in presenting educational materials in this journal are commendable. Best wishes from, Farahnaz Fallahian.
Dear Maria Emerson, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. I am delighted to have published our manuscript, "Acute Colonic Pseudo-Obstruction (ACPO): A rare but serious complication following caesarean section." I want to thank the editorial team, especially Maria Emerson, for their prompt review of the manuscript, quick responses to queries, and overall support. Yours sincerely Dr. Victor Olagundoye.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. Many thanks for publishing this manuscript after I lost confidence the editors were most helpful, more than other journals Best wishes from, Susan Anne Smith, PhD. Australian Breastfeeding Association.
Dear Agrippa Hilda, Editorial Coordinator, Journal of Neuroscience and Neurological Surgery. The entire process including article submission, review, revision, and publication was extremely easy. The journal editor was prompt and helpful, and the reviewers contributed to the quality of the paper. Thank you so much! Eric Nussbaum, MD
Dr Hala Al Shaikh This is to acknowledge that the peer review process for the article ’ A Novel Gnrh1 Gene Mutation in Four Omani Male Siblings, Presentation and Management ’ sent to the International Journal of Clinical Case Reports and Reviews was quick and smooth. The editorial office was prompt with easy communication.
Dear Erin Aust, Editorial Coordinator, Journal of General Medicine and Clinical Practice. We are pleased to share our experience with the “Journal of General Medicine and Clinical Practice”, following the successful publication of our article. The peer review process was thorough and constructive, helping to improve the clarity and quality of the manuscript. We are especially thankful to Ms. Erin Aust, the Editorial Coordinator, for her prompt communication and continuous support throughout the process. Her professionalism ensured a smooth and efficient publication experience. The journal upholds high editorial standards, and we highly recommend it to fellow researchers seeking a credible platform for their work. Best wishes By, Dr. Rakhi Mishra.
Dear Jessica Magne, Editorial Coordinator, Clinical Cardiology and Cardiovascular Interventions, Auctores Publishing LLC. The peer review process of the journal of Clinical Cardiology and Cardiovascular Interventions was excellent and fast, as was the support of the editorial office and the quality of the journal. Kind regards Walter F. Riesen Prof. Dr. Dr. h.c. Walter F. Riesen.
Dear Ashley Rosa, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews, Auctores Publishing LLC. Thank you for publishing our article, Exploring Clozapine's Efficacy in Managing Aggression: A Multiple Single-Case Study in Forensic Psychiatry in the international journal of clinical case reports and reviews. We found the peer review process very professional and efficient. The comments were constructive, and the whole process was efficient. On behalf of the co-authors, I would like to thank you for publishing this article. With regards, Dr. Jelle R. Lettinga.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, I would like to express my deep admiration for the exceptional professionalism demonstrated by your journal. I am thoroughly impressed by the speed of the editorial process, the substantive and insightful reviews, and the meticulous preparation of the manuscript for publication. Additionally, I greatly appreciate the courteous and immediate responses from your editorial office to all my inquiries. Best Regards, Dariusz Ziora
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation, Auctores Publishing LLC, We would like to thank the editorial team for the smooth and high-quality communication leading up to the publication of our article in the Journal of Neurodegeneration and Neurorehabilitation. The reviewers have extensive knowledge in the field, and their relevant questions helped to add value to our publication. Kind regards, Dr. Ravi Shrivastava.
Dear Clarissa Eric, Editorial Coordinator, Journal of Clinical Case Reports and Studies, Auctores Publishing LLC, USA Office: +1-(302)-520-2644. I would like to express my sincere appreciation for the efficient and professional handling of my case report by the ‘Journal of Clinical Case Reports and Studies’. The peer review process was not only fast but also highly constructive—the reviewers’ comments were clear, relevant, and greatly helped me improve the quality and clarity of my manuscript. I also received excellent support from the editorial office throughout the process. Communication was smooth and timely, and I felt well guided at every stage, from submission to publication. The overall quality and rigor of the journal are truly commendable. I am pleased to have published my work with Journal of Clinical Case Reports and Studies, and I look forward to future opportunities for collaboration. Sincerely, Aline Tollet, UCLouvain.
Dear Ms. Mayra Duenas, Editorial Coordinator, International Journal of Clinical Case Reports and Reviews. “The International Journal of Clinical Case Reports and Reviews represented the “ideal house” to share with the research community a first experience with the use of the Simeox device for speech rehabilitation. High scientific reputation and attractive website communication were first determinants for the selection of this Journal, and the following submission process exceeded expectations: fast but highly professional peer review, great support by the editorial office, elegant graphic layout. Exactly what a dynamic research team - also composed by allied professionals - needs!" From, Chiara Beccaluva, PT - Italy.
Dear Maria Emerson, Editorial Coordinator, we have deeply appreciated the professionalism demonstrated by the International Journal of Clinical Case Reports and Reviews. The reviewers have extensive knowledge of our field and have been very efficient and fast in supporting the process. I am really looking forward to further collaboration. Thanks. Best regards, Dr. Claudio Ligresti
Dear Chrystine Mejia, Editorial Coordinator, Journal of Neurodegeneration and Neurorehabilitation. “The peer review process was efficient and constructive, and the editorial office provided excellent communication and support throughout. The journal ensures scientific rigor and high editorial standards, while also offering a smooth and timely publication process. We sincerely appreciate the work of the editorial team in facilitating the dissemination of innovative approaches such as the Bonori Method.” Best regards, Dr. Matteo Bonori.
I recommend without hesitation submitting relevant papers on medical decision making to the International Journal of Clinical Case Reports and Reviews. I am very grateful to the editorial staff. Maria Emerson was a pleasure to communicate with. The time from submission to publication was an extremely short 3 weeks. The editorial staff submitted the paper to three reviewers. Two of the reviewers commented positively on the value of publishing the paper. The editorial staff quickly recognized the third reviewer’s comments as an unjust attempt to reject the paper. I revised the paper as recommended by the first two reviewers.
Dear Maria Emerson, Editorial Coordinator, Journal of Clinical Research and Reports. Thank you for publishing our case report: "Clinical Case of Effective Fetal Stem Cells Treatment in a Patient with Autism Spectrum Disorder" within the "Journal of Clinical Research and Reports" being submitted by the team of EmCell doctors from Kyiv, Ukraine. We much appreciate a professional and transparent peer-review process from Auctores. All research Doctors are so grateful to your Editorial Office and Auctores Publishing support! I amiably wish our article publication maintained a top quality of your International Scientific Journal. My best wishes for a prosperity of the Journal of Clinical Research and Reports. Hope our scientific relationship and cooperation will remain long lasting. Thank you very much indeed. Kind regards, Dr. Andriy Sinelnyk Cell Therapy Center EmCell
