Acute viral myocarditis

Abstract

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.

DCMP as a Clinical Syndrome: Results of Nosological Diagnostics With Myocardial Biopsy and Differentiated Treatment in Virus-Positive and Virus-Negative Patients

“…Однако в целом ряде других работ была показана успешность применения ИСТ у вирус-позитивных больных в соче-тании с противовирусным лечением: у детей с острым, а также с хроническим миокардитом и синдромом ДКМП, при котором выраженный эффект ИСТ был получен независимо от персистенции вирусов в мио-карде при отсутствии улучшения в группе контроля [26,27]; у взрослых с тяжелым вирусным миокардитом [28,29]. Маастрихтский алгоритм подразумевает при одновременном выявлении вирусного генома в мио-карде и антикардиальных антител проведение проти-вовирусного лечения с последующей ИСТ [30]; анало-гичных принципов придерживается группа Andréoletti L, et al [31].…”

Improvement of left ventricular systolic function in inflammatory cardiomyopathy: What plays a role?

“…Inclusion criteria were as follows: heart failure symptoms of at least NYHA II, symptoms duration ≤ 6 months, left ventricular ejection fraction (LVEF) ≤ 40% assessed by echocardiography, biopsy findings of > 14 mononuclear leukocytes cells/mm 2 (LCA+ cells) consistent with the diagnosis of lymphocytic myocarditis (ref. 8,11,13,14,16,31,33 ). Patients with coronary artery disease, significant valvular disease, toxic myocardial damage caused by alcohol or chemotherapy, endocrine disorders or tachycardiainduced LV dysfunction were excluded.…”

“…Clinical suspicion of myocarditis is raised by the presence of any of the described symptoms and simultaneous fulfillment of at least one of the diagnostic criteria from examinations such as ECG, laboratory findings, echocardiographic or magnetic resonance imaging as described elsewhere 4 . However, the definitive diagnosis of myocarditis is always histological and/or immunohistochemical which require a sample of myocardium for confirmation of the inflammation 4,[7][8][9] . A myocardial sample is commonly obtained transvascularly from the right or left ventricle using endomyocardial biopsy (EMB).…”

“…A myocardial sample is commonly obtained transvascularly from the right or left ventricle using endomyocardial biopsy (EMB). EMB is considered the gold standard for myocarditis diagnosis and is also the only method able to confirm a final diagnosis in vivo [6][7][8][9][10] . According to the WHO / ISCF definition of 1995 diagnosis of myocarditis is based on histological, immunological and immunohistochemical criteria 11 .…”

“…It is estimated that in about 50-70% of patients, the healing of myocarditis is associated with the improvement or normalization of LV systolic function. On the other hand, in some cases, LV dysfunction persists or even progresses to refractory failure 4,5,[7][8][9][10]28 . There are a number of factors that play a role in the course of the disease, for instance type of myocarditis, grade of initial myocardial injury, hormonal factors, physical stress during the acute phase of the disease, the intensity and duration of the inflammatory process and persistence or replication of the virus in the myocardium 5,7,9,10,[28][29][30] .…”