Journal
HERZ
Volume 37, Issue 6, Pages 644-656Publisher
URBAN & VOGEL
DOI: 10.1007/s00059-012-3679-9
Keywords
Viral and autoimmune myocarditis; Polymerase chain reaction; Heart failure therapy; Antiviral treatment; Intravenous immunoglobulins; Immunosuppression
Categories
Funding
- Bundesministerium fur Wissenschaft und Forschung (BMBF) in the German Competence Net of Heart Failure (KNHI)
- Dr. Reinfried Pohl Foundation
- Marburg Heart Foundation (VFDK)
- UKGM Foundation
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In inflammatory dilated cardiomyopathy and myocarditis there is-apart from heart failure and antiarrhythmic therapies-no alternative to an aetiologically driven specific treatment. Prerequisite are noninvasive and invasive biomarkers including endomyocardial biopsy and PCR on cardiotropic agents. This review deals with the different etiologies of myocarditis and inflammatory cardiomyopathy including the genetic background, the predisposition for heart failure and inflammation. It analyses the epidemiologic shift in pathogenetic agents in the last 20 years, the role of innate and aquired immunity including the T- and B-cell driven immune responses. The phases and clinical faces of myocarditis are summarized. Up-to-date information on current treatment options starting with heart failure and antiarrhythmic therapy are provided. Although inflammation can resolve spontaneously, specific treatment directed to the causative aetiology is often required. For fulminant, acute and chronic autoreactive myocarditis immunosuppressive treatment is beneficial, while for viral cardiomyopathy and myocarditis ivIg can resolve inflammation and is as successful as interferon therapy in enteroviral and adenoviral myocarditis. For Parvo B19 and HHV6 myocarditis eradication of the virus is still a problem by any of these treatment options. Finally, the potential of stem cell therapy has to be tested in future trials. In virus-negative, autoreactive perimyocardial disease a locoregional approach with intrapericardial instillation of high local doses of triamcinolone acetate has been shown to be highly efficient and with few systemic side-effects.
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