Myocarditis--a frequent cause of dilated cardiomyopathy and sudden cardiac death--typically results from cardiotropic viral infection followed by active inflammatory destruction of the myocardium. Characterization of this disease has been hampered by its heterogeneous clinical presentations and diverse aetiologies. Advances in cardiac MRI and molecular detection of viruses by endomyocardial biopsy have improved our ability to diagnose and understand the pathophysiological mechanisms of this elusive disease. However, therapeutic options are currently limited for both the acute and chronic phases of myocarditis. Several randomized, controlled trials have demonstrated potential benefit with immunosuppressive and immunomodulatory therapies, but further investigations are warranted. In this Review, we explore the pathophysiology, natural history, and modes of diagnosis of myocarditis, as well as evidence-based treatment strategies. As novel imaging techniques and human in vitro models of the disease emerge, the landscape of therapies for myocarditis is poised to improve.
The respiratory turbinates of mammals are complex bony plates within the nasal chamber that are covered with moist epithelium and provide an extensive surface area for the exchange of heat and water. Given their functional importance, maxilloturbinate size and structure are expected to vary predictably among species adapted to different environments. Here the first quantitative analysis is provided of maxilloturbinate structure based on high-resolution computed tomography (CT) scans of the skulls of eight canid and seven felid species. The key parameters examined were the density of the maxilloturbinate bones within the nasal chamber and how that density varied along the air pathway. In both canids and felids, total maxilloturbinate chamber volume and bone volume increased with body size, with canids having c. 1.5-2.0 times the volume of maxilloturbinate than felids of similar size. In all species, the volume of the maxilloturbinates varies from rostral to caudal, with the peak volume occurring approximately midway, close to where airway cross-sectional area is greatest. Interspecific differences among canids or felids in maxilloturbinate density were not consistent with adaptive explanations, i.e. the densest maxilloturbinates were not associated with species living in arid or cold habitats. Some of the observed variation in maxilloturbinate form might reflect a need for both low-and high-resistance pathways for airflow under alternative conditions.
Cardiac allograft vasculopathy (CAV) is an important cause of morbidity and mortality among cardiac transplant recipients. CAV occurs in approximately 30% of patients by 5 years and 50% by 10 years, and is a major cause of graft loss and death. Early detection of CAV is important because it may allow alterations in medical therapy before progression to the stage that revascularization is required. This has led to routine screening for CAV in transplant recipients, traditionally by invasive coronary angiography (ICA). Recent advances in imaging technology, specifically intravascular ultrasound, now also permit detection of subangiographic CAV. Noninvasive stress testing and multislice coronary computed tomography angiography have been investigated as noninvasive alternatives to routine ICA. However, currently available noninvasive tests remain limited with respect to their sensitivity and specificity for CAV. Given the multiple available diagnostic modalities, no consensus definition for the classification of CAV has been widely accepted, although new guidelines that rely heavily on ICA have recently been published by the International Society of Heart and Lung Transplantation. This review summarizes imaging modalities that are utilized in the diagnosis and surveillance of CAV and explores newer imaging techniques that may play a future role.
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