Myocarditis and heart failure: need for better diagnostic, predictive, and therapeutic tools
2007; Oxford University Press; Volume: 28; Issue: 11 Linguagem: Inglês
10.1093/eurheartj/ehm111
ISSN1522-9645
Autores Tópico(s)Cardiac Structural Anomalies and Repair
ResumoViral infection of the heart is increasingly recognized as an important cause of both acute and chronic heart failure. Enteroviruses and adenoviruses have been considered the most common pathogens of viral cardiomyopathy (CMP), but parvovirus B19 (PVB19) is increasingly found in endomyocardial biopsies of patients with acute myocarditis or idiopathic dilated cardiomyopathy (ICM).1,2 In addition to direct cytopathic effects of these cardiotropic viruses, there is convincing evidence that autoimmune responses induced by viruses contribute to the heart disease in a significant subset of patients with myocarditis.3 Caforio et al .4 present a prospective study in 174 consecutive patients with myocarditis included between 1992 and 2005. They identify biventricular dysfunction as the main predictor of death or transplantation. A myocardial biopsy and serum anti-heart autoantibodies (AHA)-driven diagnosis and classification of myocarditis patients are used. As such, viral genome present in biopsies is further identified as a univariate predictor of adverse prognosis. Importance of a thoughtful and generally accepted classification of patients with myocarditis to allow further studies on pathogenesis, prognosis, and treatment of myocarditis is underlined by this study. Clinically, patients with acute viral myocarditis will spontaneously recover in about three-fourth of cases, whereas the remaining one-fourth will develop progressive heart failure. Cardiac biopsies and autoimmune serology are therefore essential in the diagnostic process of myocarditis evolving to ICM. … Corresponding author. Tel: +31 43 3882949; fax: +31 43 3871055. E-mail address : s.heymans{at}cardio.unimaas.nl
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