Literature review of myasthenia gravis complicated by myocardial damage

Background: Myasthenia gravis (MG) is a chronic autoimmune disorder predominantly driven by pathogenic autoantibodies directed against postsynaptic acetylcholine receptors, impairing neuromuscular transmission. Although cardiovascular complications remain relatively uncommon among MG patients, their emergence markedly elevates the risk of fatal outcomes. This review synthesizes existing evidence to delineate the clinical manifestations of MG-associated myocardial damage, offering clinicians a comprehensive framework for early detection and evidence-based therapeutic intervention. Methods: We analyzed 84 cases of myasthenia gravis associated with myocardial damage from the database and comprehensively evaluated their clinical characteristics. Results: The average age of patients presenting with myasthenia gravis and concurrent myocardial damage was 64.5 years. Cardiac complications predominantly included myocarditis, takotsubo cardiomyopathy, acute myocardial infarction, and coronary spastic angina. Serological analysis revealed 2 principal autoantibodies: acetylcholine receptor (AChR) antibody and anti-titin antibody. Clinical outcomes demonstrated a 72.6% survival rate alongside a 23.8% case fatality rate. These variables were more frequently observed among fatal cases but were not statistically associated with mortality: AChR antibody positivity, thymoma, myocarditis, immune checkpoint inhibitor use, and acute myocardial infarction. Conclusion: This study represents the inaugural comprehensive analysis examining the association between myasthenia gravis and concurrent cardiac injury. Our research elucidates potential pathophysiological pathways underlying this clinical entity. These findings highlight the need for clinical awareness and screening of myocardial involvement in MG patients and may provide preliminary evidence for future consensus development.