Myocarditis and inflammatory cardiomyopathy: from diagnosis to treatment
Felicitas Escher1, Carsten Tschöepe2, Dirk Lassner3
1Institute for Cardiac Diagnostics and Therapy (IKDT), Berlin, Germany; Department of Cardiology, Campus Virchow Klinikum, Charite - Universitaetsmedizin Berlin, Berlin, Germany. heinz-peter.schultheiss@charite.de.
Insights
Myocarditis, an inflammation of the heart muscle, and inflammatory cardiomyopathy, which includes cardiac dysfunction, have uncertain incidences. Myocarditis can lead to dilated cardiomyopathy and carries a variable prognosis.
Area of Science:
- Cardiology
- Pathology
Background:
- Myocarditis is defined as myocardial inflammation meeting specific diagnostic criteria.
- Inflammatory cardiomyopathy is diagnosed when myocarditis is associated with cardiac dysfunction.
Purpose of the Study:
- To determine the actual incidences of myocarditis and inflammatory cardiomyopathy.
- To review the prevalence and prognosis of myocarditis.
Main Methods:
- Review of studies on sudden cardiac death in young people.
- Analysis of biopsy-proven myocarditis in adult patients with unexplained nonischemic dilated cardiomyopathy.
Main Results:
- Autopsy prevalence of myocarditis in sudden cardiac death cases ranges widely from 2-42%.
- Biopsy-proven myocarditis is found in 9-16% of adults with unexplained nonischemic dilated cardiomyopathy.
- Up to 30% of biopsy-proven myocarditis cases may progress to dilated cardiomyopathy with a poor prognosis.
Conclusions:
- The exact incidence of myocarditis and inflammatory cardiomyopathy remains challenging to ascertain.
- Prognosis in myocarditis is variable and depends on the underlying cause and potential progression to dilated cardiomyopathy.
Abstract:
Based on the definition in the European Society of Cardiology statement, myocarditis is an inflammatory disease of the myocardium diagnosed by established histological, immunological, and immunohistochemical criteria, whereas inflammatory cardiomyopathy is myocarditis in association with cardiac dysfunction. Actual incidences of myocarditis and CMi are difficult to determine. Studies addressing the issue of sudden cardiac death in young people report a highly variable autopsy prevalence of myocarditis, ranging from 2-42% of cases. Similarly, biopsy-proven myocarditis has been reported in 9-16% of adult patients with unexplained nonischemic dilated cardiomyopathy (DCM). In up to 30% of cases, biopsy-proven myocarditis can progress to DCM and is associated with a poor prognosis. Prognosis in myocarditis patients also varies according to underlying etiology.
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