Overview on Chronic Viral Cardiomyopathy/Chronic Myocarditis

摘要: Myocarditis is most often induced by cardiotropic viruses and resolves with minimal cardiac remodelling 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 severely depressed contractility). Progression of its sequela, dilated cardiomyopathy (DCM), been documented in 20% cases pathogenically linked chronic inflammation viral persistence. Persistence (enterovirus, adenovirus) constitutes one the predominant aetiological factors DCM. Additionally, circulating autoantibodies distinct autoantigens have described patients DCM, providing evidence for autoimmune involvement. Since complaints DCM are unspecific, positive effect any specific therapy depends on an accurate biopsy-based diagnosis characterization histological, immunohistological molecular biological methods (PCR), which developed into sensitive tools detection different viruses, active replication, myocardial inflammation. The immunohistochemical infiltrates supported new era compared Dallas criteria, led entity secondary cardiomyopathies acknowledged WHO, inflammatory (DCMi). Immunohistochemically quantified lymphocytes significantly better reflect troponin levels correlate findings anti-myosin scintigraphy histological analysis. Furthermore, orchestrated induction endothelial cell adhesion molecules (CAMs) 65% confirmed that CAM prerequisite lymphocytic infiltration DCMi. combination these diagnostic techniques virus analysis allows further classification differentiating disease subgroups virus-positive virus-negative or Further Th1-/Th2-immune response may provide additional information natural course disease. This differential improves management indispensable development antiviral immunomodulatory treatment strategies.