Morphologie der Myokarditis

Doerr, Wilhelm

doi:10.1007/978-3-642-85466-8_16

Cited by 10 publications

(3 citation statements)

References 38 publications

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“…Channelopathies [46] as such are therefore not necessarily cardiomyopathies in "sensu strictu" but rather cardiopathies [40], as the position statement of the ESC (European Society of Cardiology) Working Group correctly points out, when defining the European point of view [14] in comparison to the Herz 32 · 2007 · Nr. Among the several histological classifications [12], the Dallas classification [8] is still used in many instances. The clinical and pathologic phenotype of myocarditis or inflammatory cardiomyopathy can be like a chameleon.…”

Section: Dilated Cardiomyopathiesmentioning

confidence: 99%

Integrated Biomarkers in Cardiomyopathies

Schulz‐Menger

Maisch

Abdel-Aty

et al. 2007

Herz

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In an integrated approach, the authors examine the most efficient combination of noninvasive and invasive biochemical, immunologic, functional, molecular, imaging and biopsy-derived biomarkers for their applicability in the diagnosis of cardiomyopathies in general and dilated cardiomyopathy (DCM) in particular. A careful selection out of the cascade of available biomarkers will allow, in individual patients, to diagnose certain conditions of cardiomyopathies without endomyocardial biopsy, e.g., borreliosis, rickettsiosis, HIV cardiomyopathy. Viral persistence in DCM associated with inflammation will need both noninvasive (echocardiography, cardiovascular magnetic resonance) and invasive biomarkers (polymerase chain reaction for viral persistence or their exclusion in case of autoreactive myocarditis and quantitative immunohistology, both from endomyocardial biopsy).

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Section: Dilated Cardiomyopathiesmentioning

confidence: 99%

Integrated Biomarkers in Cardiomyopathies

Schulz‐Menger

Maisch

Abdel-Aty

et al. 2007

Herz

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“…1971 wies er darauf hin -und auch dies ist aktuell -, "gerade der Erfahrene spricht seine Sprache und macht sich sein Bild von seiner Entzündung ...". Die Diagnose einer Myokarditis hängt davon ab, "je nachdem welche Begriffsbestimmung gewählt wird" [17].…”

Section: Historischer üBerblick Zur Problematik Der Myokarditisdiagnoseunclassified

Indikation der Herzmuskelbiopsie bei Myokarditis und dilatativer Kardiomyopathie

Kuhn

Lawrenz²,

Beer

2005

Med Klin

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This review may serve as a basis for evaluating publications on the topic "myocardial biopsy for myocarditis and dilated cardiomyopathy" in the clinical practice. The literature is particularly analyzed to answer the question, whether an endomyocardial catheter biopsy is indicated in patients with these myocardial disorders in the clinical routine besides its unequivocal scientific value. The judgment of the biopsy samples has been based on the classically histological and for years on the additional immunohistochemical and molecular biological-virological examination. The analysis of the literature data shows that outside scientific studies there is no indication to perform myocardial biopsy, or in other words, this procedure is not suitable for diagnosis, therapy, detection of early stages or prognostic evaluation in the disease spectrum "myocarditis, inflammatory heart disease, dilated cardiomyopathy". Reasons are the subjectivity in the judgment and interpretation of bioptic findings resulting in considerable interobserver variability, a missing standardization in biopsy performance, methods of examination and diagnostic criteria, the bioptic sampling error, missing therapeutic and prognostic consequences and potentially severe complications in performing myocardial biopsies. So far, the specificity of inflammatory changes in patients with dilated cardiomyopathy has not been proven in controlled blinded studies. The bioptic changes could be understood also as an unspecific inflammatory process in front of increasing pathophysiological evidence for myocardial inflammation in any form of heart failure. In addition, regarding the specific etiology of dilated cardiomyopathy, primarily a genetic, noninfectious or autoimmunologic origin plays an increasing role. The favorable clinical course and the very good prognosis of the acute, clinically diagnosed or supposed viral myocarditis should also be taken into account for the evaluation of myocardial biopsy. It should also be considered that the proof of causality between acute myocarditis and dilated cardiomyopathy is still lacking. Regarding the diagnosis "inflammatory cardiomyopathy" and multiple inflammatory subsets among patients with dilated cardiomyopathy or unclear regional contraction disorder, there is no adequate clinical validation of different diagnostic methods, criteria and interpretations so far. It is missleading to replace the well-established clinical diagnosis myocarditis by the bioptic diagnosis "inflammatory cardiomyopathy". However, endomyocardial catheter biopsy is clearly indicated in rare patients with fulminant myocarditis, giant-cell myocarditis and myocardial storage disease. Its probably underestimated role in sarcoid heart disease still needs to be clarified by systematic studies.

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“…Die Myokarditis ist in allen Lebensaltern eine seltene Erkrankung. So berichtete Doerr (8) 1971 von einer Häufigkeit der Myokarditis im gesamten Obduktionsgut des Pathologischen Instituts in Heidelberg von 3,98%, was auch früheren pathologisch-anatomischen Studien sehr gut entsprach. Bei 90 plötzlich verstorbenen Kindern fand man in Minnesota bei 17% autoptisch eine Myokarditis (4).…”

Section: Häufigkeit Und Epidemiologieunclassified

Die Myokarditis im Kindesalter

Aa¹

1991

Klin Padiatr

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Infectious heart diseases in childhood are--with less than 1% of hospital admissions--rare, but serious diseases. Among several causes of myocarditis in our region virus myocarditis plays the most important role. Besides of the acute course an autoimmune mediated chronic myocarditis and the transition to dilated cardiomyopathy are observed. The patho-histological assessment depends also on subjective influences. Clinical diagnosis is based on cardiac symptoms (Adams-Stokes, congestive heart failure, LV-dilatation), ECG-changes with increased enzyme levels and positive virus-serology or endomyocardial biopsy. Immunoserology and -histology as well as in-situ-hybridization can support diagnosis, echocardiography and eventually heart catheterization exclude other causes. In respect to therapy, ACE-inhibitors are a substantial improvement of conventional therapy of heart failure, while immunosuppressive therapy of chronic myocarditis has to assessed.

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Morphologie der Myokarditis

Cited by 10 publications

References 38 publications

Integrated Biomarkers in Cardiomyopathies

Integrated Biomarkers in Cardiomyopathies

Indikation der Herzmuskelbiopsie bei Myokarditis und dilatativer Kardiomyopathie

Die Myokarditis im Kindesalter

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