Document Detail

Overview on chronic viral cardiomyopathy/chronic myocarditis.
MedLine Citation:
PMID:  16329654     Owner:  NLM     Status:  MEDLINE    
Myocarditis is most often induced by cardiotropic viruses and often resolves with minimal cardiac remodelling and without discernable prognostic impact. Acute myocarditis has a highly diverse clinical presentation (asymptomatic, infarct-like presentation, atrioventricular (AV)-block, atrial fibrillation, sudden death due to ventricular tachycardia, fulminant myocarditis with severely depressed contractility). Progression of myocarditis to its sequela, dilated cardiomyopathy (DCM), has been documented in 20% of cases and is pathogenically linked to chronic inflammation and viral persistence. Persistence of cardiotropic viruses (enterovirus, adenovirus) constitutes one of the predominant aetiological factors in DCM. Additionally, circulating autoantibodies to distinct cardiac autoantigens have been described in patients with DCM, providing evidence for autoimmune involvement. Since clinical complaints of myocarditis and DCM are unspecific, a positive effect of any specific therapy depends on an accurate biopsy-based diagnosis and characterization of the patients with histological, immunohistological and molecular biological methods (PCR), which have developed into sensitive tools for the detection of different viruses, active viral replication, and myocardial inflammation. The immunohistochemical characterization of infiltrates has supported a new era in the diagnosis of myocardial inflammation compared with the Dallas criteria, which has led to a new entity of secondary cardiomyopathies acknowledged by the WHO, the inflammatory cardiomyopathies (DCMi). Immunohistochemically quantified lymphocytes significantly better reflect troponin levels and correlate with findings by anti-myosin scintigraphy compared with the histological analysis. Furthermore, the orchestrated induction of endothelial cell adhesion molecules (CAMs) in 65% of DCM patients has confirmed that CAM induction is a prerequisite for lymphocytic infiltration in DCMi. The combination of these immunohistological with molecular biological diagnostic techniques of virus analysis allows a further classification of dilated cardiomyopathy by differentiating the disease entity in subgroups of virus-positive and virus-negative patients with or without cardiac inflammation. Further analysis of the predominant Th1-/Th2-immune response may provide additional prognostic information on the natural course of the disease. This differential analysis improves the clinical management of patients and is an indispensable prerequisite for the development of specific antiviral or immunomodulatory treatment strategies.
H P Schultheiss; U Kühl
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Ernst Schering Research Foundation workshop     Volume:  -     ISSN:  0947-6075     ISO Abbreviation:  Ernst Schering Res. Found. Workshop     Publication Date:  2006  
Date Detail:
Created Date:  2005-12-06     Completed Date:  2006-02-03     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9422786     Medline TA:  Ernst Schering Res Found Workshop     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  3-18     Citation Subset:  IM    
Department of Cardiology and Pneumology, Charité University Medicine Berlin, Germany.
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MeSH Terms
Cardiomyopathies / immunology,  pathology,  physiopathology*,  virology*
DNA, Viral / analysis
Endocardium / cytology,  pathology,  virology
Myocarditis / immunology,  pathology,  physiopathology*,  virology*
Virus Diseases / immunology,  pathology,  physiopathology*
Reg. No./Substance:
0/DNA, Viral

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