Acute viral myocarditis

Acute myocarditis is one of the most challenging diagnosis in cardiology. At present, no diagnostic gold standard is generally accepted, due to the insensitivity of traditional diagnostic tests. This leads to the need for new diagnostic approaches, which resulted in the emergence of new molecular tests and a more detailed immunohistochemical analysis of endomyocardial biopsies. Recent findings using these new diagnostic tests resulted in increased interest in inflammatory cardiomyopathies and a better understanding of its pathophysiology, the recognition in overlap of virus-mediated damage, inflammation, and autoimmune dysregulation. Novel results also pointed towards a broader spectrum of viral genomes responsible for acute myocarditis, indicating a shift of enterovirus and adenovirus to parvovirus B19 and human herpes virus 6. The present review proposes a general diagnostic approach, focuses on the viral aetiology and associated autoimmune processes, and reviews treatment options for patients with acute viral myocarditis.

[1]  M. Cheitlin.  Coronary vasospasm as the underlying cause for chest pain in patients with PVB19 myocarditis , 2009 .

[2]  D. Pennell,et al.  The role of endomyocardial biopsy in the management of cardiovascular disease: a scientific statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology. , 2008, European heart journal.

[3]  Sabino Iliceto,et al.  Genetically determined myocarditis: clinical presentation and immunological characteristics , 2008, Current opinion in cardiology.

[4]  M. Gutberlet,et al.  Suspected chronic myocarditis at cardiac MR: diagnostic accuracy and association with immunohistologically detected inflammation and viral persistence. , 2008, Radiology.

[5]  L. Stevenson,et al.  Task force 8: training in heart failure endorsed by the Heart Failure Society of America. , 2008, Journal of the American College of Cardiology.

[6]  A. Angelini,et al.  A prospective study of biopsy-proven myocarditis: prognostic relevance of clinical and aetiopathogenetic features at diagnosis. , 2007, European heart journal.

[7]  S. Heymans.  Myocarditis and heart failure: need for better diagnostic, predictive, and therapeutic tools. , 2007, European heart journal.

[8]  Peter P. Liu,et al.  Connecting the missing link between dilated cardiomyopathy and viral myocarditis: virus, cytoskeleton, and innate immunity. , 2006, Circulation.

[9]  P. Elliott,et al.  Prospective Familial Assessment in Dilated Cardiomyopathy: Cardiac Autoantibodies Predict Disease Development in Asymptomatic Relatives , 2006, Circulation.

[10]  L. Cooper,et al.  Noninvasive imaging in myocarditis. , 2006, Journal of the American College of Cardiology.

[11]  K. Klingel,et al.  Presentation, Patterns of Myocardial Damage, and Clinical Course of Viral Myocarditis , 2006, Circulation.

[12]  P. Carmeliet,et al.  Inhibition of Urokinase-Type Plasminogen Activator or Matrix Metalloproteinases Prevents Cardiac Injury and Dysfunction During Viral Myocarditis , 2006, Circulation.

[13]  K. Baughman.  Diagnosis of myocarditis: death of Dallas criteria. , 2006, Circulation.

[14]  P. Liu,et al.  Recent insights into the role of host innate and acquired immunity responses. , 2006, Ernst Schering Research Foundation workshop.

[15]  S. Heymans.  Inflammation and cardiac remodeling during viral myocarditis. , 2006, Ernst Schering Research Foundation workshop.

[16]  Fabien Hyafil,et al.  Differentiating acute myocardial infarction from myocarditis: diagnostic value of early- and delayed-perfusion cardiac MR imaging. , 2005, Radiology.

[17]  H. Schultheiss,et al.  Viral Persistence in the Myocardium Is Associated With Progressive Cardiac Dysfunction , 2005, Circulation.

[18]  Diethelm Wallwiener,et al.  High prevalence of viral genomes and inflammation in peripartum cardiomyopathy. , 2005, American journal of obstetrics and gynecology.

[19]  J. Schulz-Menger,et al.  Diagnostic performance of cardiovascular magnetic resonance in patients with suspected acute myocarditis: comparison of different approaches. , 2005, Journal of the American College of Cardiology.

[20]  A. Yan,et al.  Cardiovascular magnetic resonance for the diagnosis of acute myocarditis: prospects for detecting myocardial inflammation. , 2005, Journal of the American College of Cardiology.

[21]  R. Kandolf,et al.  High Prevalence of Viral Genomes and Multiple Viral Infections in the Myocardium of Adults With “Idiopathic” Left Ventricular Dysfunction , 2005, Circulation.

[22]  L. Lustig,et al.  Alterations in cardiac muscarinic acetylcholine receptors in mice with autoimmune myocarditis and association with circulating muscarinic receptor-related autoantibodies , 1994, Clinical Autonomic Research.

[23]  A. Berrebi,et al.  Fulminant myocarditis in adults and children: bi-ventricular assist device for recovery. , 2004, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[24]  N. Rose,et al.  Autoimmune myocarditis: cellular mediators of cardiac dysfunction. , 2004, Autoimmunity reviews.

[25]  Udo Sechtem,et al.  Cardiovascular Magnetic Resonance Assessment of Human Myocarditis: A Comparison to Histology and Molecular Pathology , 2004, Circulation.

[26]  C. Semsarian,et al.  Causes of sudden cardiac death in young Australians , 2004, The Medical journal of Australia.

[27]  H. Schultheiss,et al.  Myocardial Remodeling in Viral Heart Disease: Possible Interactions Between Inflammatory Mediators and MMP-TIMP System , 2004, Heart Failure Reviews.

[28]  C. Badorff,et al.  Dystrophin disruption in enterovirus-induced myocarditis and dilated cardiomyopathy: from bench to bedside , 2004, Medical Microbiology and Immunology.

[29]  R. Asinger,et al.  ST-segment elevation in conditions other than acute myocardial infarction. , 2003, The New England journal of medicine.

[30]  Yoshimasa Tanaka,et al.  Autoantibodies against cardiac troponin I are responsible for dilated cardiomyopathy in PD-1-deficient mice , 2003, Nature Medicine.

[31]  J. Mason.  Myocarditis and dilated cardiomyopathy: an inflammatory link. , 2003, Cardiovascular research.

[32]  J. Towbin,et al.  Detection of viruses in myocardial tissues by polymerase chain reaction. evidence of adenovirus as a common cause of myocarditis in children and adults. , 2003, Journal of the American College of Cardiology.

[33]  C H Lorenz,et al.  Differentiation of Heart Failure Related to Dilated Cardiomyopathy and Coronary Artery Disease Using Gadolinium‐Enhanced Cardiovascular Magnetic Resonance , 2003, Circulation.

[34]  H. Schultheiss,et al.  Interferon- (cid:1) Treatment Eliminates Cardiotropic Viruses and Improves Left Ventricular Function in Patients With Myocardial Persistence of Viral Genomes and Left Ventricular Dysfunction , 2003 .

[35]  B. Maisch,et al.  Prevalence of the parvovirus B19 genome in endomyocardial biopsy specimens. , 2003, Human pathology.

[36]  G. Thiene,et al.  Immunosuppressive Therapy for Active Lymphocytic Myocarditis: Virological and Immunologic Profile of Responders Versus Nonresponders , 2003, Circulation.

[37]  H. Schultheiss,et al.  Interferon-beta treatment eliminates cardiotropic viruses and improves left ventricular function in patients with myocardial persistence of viral genomes and left ventricular dysfunction. , 2003, Circulation.

[38]  L. McLain,et al.  Sudden death in young athletes. , 2003, Pediatric annals.

[39]  N. Takeda.  Cardiomyopathy: molecular and immunological aspects (review). , 2003, International journal of molecular medicine.

[40]  Tuba Kirci Torun,et al.  Phenotypic characterization of infiltrates in dilated cardiomyopathy--diagnostic significance of T-lymphocytes and macrophages in inflammatory cardiomyopathy. , 2002, Medical science monitor : international medical journal of experimental and clinical research.

[41]  W. McKenna,et al.  Circulating cardiac autoantibodies in dilated cardiomyopathy and myocarditis: pathogenetic and clinical significance , 2002, European journal of heart failure.

[42]  E. Antman,et al.  ACC/AHA PRACTICE GUIDELINES ACC/AHA Guidelines for the Evaluation and Management of Chronic Heart Failure in the Adult: Executive Summary , 2002 .

[43]  M. Rich,et al.  AHA Conference Proceedings: Do existing databases hold the answers to clinical questions in geriatric cardiovascular disease and stroke? Executive Summary. Database Conference, January 27-30, 2000. Washington, DC, USA. , 2001, Circulation.

[44]  D. Mann,et al.  Left Ventricular Remodeling in Transgenic Mice With Cardiac Restricted Overexpression of Tumor Necrosis Factor , 2001, Circulation.

[45]  Romuald Wojnicz,et al.  Randomized, Placebo-Controlled Study for Immunosuppressive Treatment of Inflammatory Dilated Cardiomyopathy: Two-Year Follow-Up Results , 2001, Circulation.

[46]  R. Holubkov,et al.  Controlled Trial of Intravenous Immune Globulin in Recent-Onset Dilated Cardiomyopathy , 2001, Circulation.

[47]  A. di Lenarda,et al.  The fate of acute myocarditis between spontaneous improvement and evolution to dilated cardiomyopathy: a review , 2001, Heart.

[48]  G Thiene,et al.  Postmortem diagnosis in sudden cardiac death victims: macroscopic, microscopic and molecular findings , 2001, Cardiovascular research.

[49]  D. Le Guludec,et al.  Myocarditis in patients with clinical presentation of myocardial infarction and normal coronary angiograms. , 2001, Journal of the American College of Cardiology.

[50]  K. Kawamura,et al.  Evaluation of viral infection in the myocardium of patients with idiopathic dilated cardiomyopathy. , 2000, Journal of the American College of Cardiology.

[51]  C. Badorff,et al.  Dissociation of Sarcoglycans and the Dystrophin Carboxyl Terminus From the Sarcolemma in Enteroviral Cardiomyopathy , 2000, Circulation research.

[52]  R. Hruban,et al.  Echocardiographic findings in fulminant and acute myocarditis. , 2000, Journal of the American College of Cardiology.

[53]  N. Sarvetnick,et al.  Pancreatic expression of interferon-γ protects mice from lethal coxsackievirus B3 infection and subsequent myocarditis , 2000, Nature Medicine.

[54]  N. Rose.  Viral damage or ‘molecular mimicry’—placing the blame in myocarditis , 2000, Nature Medicine.

[55]  A. Ristic,et al.  Definition of Inflammatory Cardiomyopathy (Myocarditis): On the Way to Consensus A Status Report , 2000, Herz.

[56]  T. Mak,et al.  The tyrosine kinase p56lck is essential in coxsackievirus B3-mediated heart disease , 2000, Nature Medicine.

[57]  C. Lawson.  Evidence for mimicry by viral antigens in animal models of autoimmune disease including myocarditis , 2000, Cellular and Molecular Life Sciences CMLS.

[58]  I. Mackay,et al.  Molecular mimicry: a critical look at exemplary instances in human diseases , 2000, Cellular and Molecular Life Sciences CMLS.

[59]  R. Hruban,et al.  Long-term outcome of fulminant myocarditis as compared with acute (nonfulminant) myocarditis. , 2000, The New England journal of medicine.

[60]  R. Kandolf,et al.  Enteroviral RNA replication in the myocardium of patients with left ventricular dysfunction and clinically suspected myocarditis. , 1999, Circulation.

[61]  B. Strauer,et al.  Cardiac troponin T in patients with clinically suspected myocarditis. , 1997, Journal of the American College of Cardiology.

[62]  A. di Lenarda,et al.  [Clinical polymorphic presentation and natural history of active myocarditis: experience in 60 cases]. , 1997, Giornale italiano di cardiologia.

[63]  J. Goldman,et al.  Circulating cardiac-specific autoantibodies as markers of autoimmunity in clinical and biopsy-proven myocarditis. The Myocarditis Treatment Trial Investigators. , 1997, European heart journal.

[64]  F. Lottspeich,et al.  Autoantibodies in sera of patients with myocarditis: characterization of the corresponding proteins by isoelectric focusing and N-terminal sequence analysis. , 1997, Journal of molecular and cellular cardiology.

[65]  A. Matsumori,et al.  Persistent expression of cytokine in the chronic stage of viral myocarditis in mice. , 1996, Circulation.

[66]  B Maisch,et al.  Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of cardiomyopathies. , 1996, Circulation.

[67]  N. Farman,et al.  Aldosterone: intracellular receptors in human heart. , 1995, European heart journal.

[68]  J. Southern,et al.  SR-Ca2+ ATPase as an autoimmunogen in experimental myocarditis. , 1995, European heart journal.

[69]  B. McManus,et al.  A clinical trial of immunosuppressive therapy for myocarditis. The Myocarditis Treatment Trial Investigators. , 1995, The New England journal of medicine.

[70]  K. Bailey,et al.  Long-term outcome of patients with biopsy-proved myocarditis: comparison with idiopathic dilated cardiomyopathy. , 1995, Journal of the American College of Cardiology.

[71]  J. Towbin,et al.  Acute Myocarditis : Rapid Diagnosis by PCR in Children 331 TABLE 1 . Dallas Criteria * General definition : Myocardial cell injury with degeneration or necrosis with inflammatory infiltrate not due to ischemia , 2005 .

[72]  C. Badorff,et al.  Transfer of human myocarditis into severe combined immunodeficiency mice. , 1994, Circulation research.

[73]  A. Matsumori,et al.  Autoantibodies against vimentin in a murine model of myocarditis. , 1994, Autoimmunity.

[74]  B. McManus,et al.  Direct myocardial injury by enterovirus: a central role in the evolution of murine myocarditis. , 1993, Clinical immunology and immunopathology.

[75]  I. Palacios,et al.  Viral myocarditis mimicking acute myocardial infarction. , 1992, Journal of the American College of Cardiology.

[76]  W. Reed,et al.  Mouse cytomegalovirus infection induces antibodies which cross-react with virus and cardiac myosin: a model for the study of molecular mimicry in the pathogenesis of viral myocarditis. , 1992, Immunology.

[77]  M. Gagliardi,et al.  Usefulness of magnetic resonance imaging for diagnosis of acute myocarditis in infants and children, and comparison with endomyocardial biopsy. , 1991, The American journal of cardiology.

[78]  H. O'Donoghue,et al.  Autoantibodies to cardiac myosin in mouse cytomegalovirus myocarditis. , 1990, Immunology.

[79]  I. Palacios,et al.  Antimyosin antibody cardiac imaging: its role in the diagnosis of myocarditis. , 1990, Journal of the American College of Cardiology.

[80]  J E Parrillo,et al.  A prospective, randomized, controlled trial of prednisone for dilated cardiomyopathy. , 1989, The New England journal of medicine.

[81]  A. J. Hauck,et al.  Evaluation of postmortem endomyocardial biopsy specimens from 38 patients with lymphocytic myocarditis: implications for role of sampling error. , 1989, Mayo Clinic proceedings.

[82]  H. Schultheiss,et al.  Laminin distribution and autoantibodies to laminin in dilated cardiomyopathy and myocarditis. , 1989, American heart journal.

[83]  H. Schultheiss,et al.  Antibodies to the ADP/ATP carrier, an autoantigen in myocarditis and dilated cardiomyopathy, penetrate into myocardial cells and disturb energy metabolism in vivo. , 1989, Circulation research.

[84]  I. Palacios,et al.  Relation between histological findings on early repeat right ventricular biopsy and ventricular function in patients with myocarditis. , 1988, British heart journal.

[85]  H. Aretz.  Myocarditis: the Dallas criteria. , 1987, Human pathology.

[86]  K. Beisel,et al.  Heart-specific autoantibodies induced by Coxsackievirus B3: identification of heart autoantigens. , 1987, Clinical immunology and immunopathology.

[87]  W. Edwards,et al.  Interobserver variability in the pathologic interpretation of endomyocardial biopsy results. , 1987, Circulation.

[88]  H. Tazelaar,et al.  The morphological progression of viral myocarditis. , 1986, Postgraduate medical journal.

[89]  J. Karjalainen,et al.  "Acute pericarditis": myocardial enzyme release as evidence for myocarditis. , 1986, American heart journal.

[90]  R. A. Johnson,et al.  Active myocarditis in the spectrum of acute dilated cardiomyopathies. Clinical features, histologic correlates, and clinical outcome. , 1985, The New England journal of medicine.

[91]  R. Gunnar,et al.  Gallium-67 imaging in patients with dilated cardiomyopathy and biopsy-proven myocarditis. , 1984, Circulation.

[92]  M. Hiroe,et al.  Long-term follow-up of electrocardiographic findings in patients with acute myocarditis proven by endomyocardial biopsy. , 1982, Japanese circulation journal.

[93]  Woodruff Jf.  Viral myocarditis. A review. , 1980 .

[94]  J. Woodruff.  Viral myocarditis. A review. , 1980, The American journal of pathology.

[95]  T. W. Mattingly.  CHANGING CONCEPTS OF MYOCARDIAL DISEASES. , 1965, JAMA.