Cor Vasa 2004, 45(4):177-182
Inflammatory cardiomyopathy: current concepts regarding its etiopathogenesis, diagnostic and therapeutic options
- 1 Klinika kardiologie
- 2 Patologicko-anatomické pracoviště, Institut klinické a experimentální medicíny, Praha, Česká republika
The most prevalent entity in the spectrum of conditions progressing into chronic heart failure in younger patients is dilated cardiomyopathy (DCMP). The term refers to a heterogeneous group of conditions resulting in left ventricular dilatation and systolic dysfunction. A major role in the etiopathogenesis of DCMP is played by previous viral myocarditis. The most frequently identified pathogens are enteroviruses and adenoviruses. Once acute infection has subsided, a virus-induced autoimmune process may occur. Patients presenting with systolic ventricular dysfunction are referred to as those with inflammatory cardiomyopathy. In this stage, the process may be reversible and some patients may benefit from immunosuppressive therapy. Histopathological diagnostic criteria defined by the presence of inflammatory cellulization and myocyte necrosis are not sufficient to diagnose this stage of the disease. An increasing role is played by the immunohistochemical methods documenting expression of adhesion molecules and Class I and II HLA antigens by interstitial cells and by cardiomyocytes. Use of these investigations may help identify patients who will benefit from immunosuppressive therapy. It is critical to rule out, prior to therapy initiation, the persistence of a viral genoma in the myocardium using recombinant DNA techniques.
Keywords: Viral myocarditis; Inflammatory cardiomyopathy; Endomyocardial biopsy; Immunohistochemistry; Immunosuppressive therapy
Published: April 1, 2004 Show citation