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Incidence and Impact of Myocarditis in Genetic Cardiomyopathies: Inflammation as a Potential Therapeutic Target
Yulia Lutokhina1, Elena Zaklyazminskaya2,3, Evgeniya Kogan4
1Institute of Clinical Medicine, V.N. Vinogradov Faculty Therapeutic Clinic, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia.
Insights
Myocarditis is common in genetic cardiomyopathies, often worsening heart failure and arrhythmias. Early diagnosis and treatment of myocarditis can improve patient outcomes in these complex cases.
Area of Science:
- Cardiology
- Genetics
- Inflammation
Background:
- Myocardial disease is a significant aspect of cardiovascular disease.
- The co-occurrence of multiple myocardial diseases in a single patient is not well understood.
Purpose of the Study:
- To determine the prevalence and effects of myocarditis in patients with genetic cardiomyopathies.
- To assess the outcomes of myocarditis treatment within the context of cardiomyopathies.
Main Methods:
- 342 patients with primary cardiomyopathies were studied, including left ventricular non-compaction (LVNC), myocardial hypertrophy syndrome, arrhythmogenic right ventricular cardiomyopathy (ARVC), dilated cardiomyopathy (DCM), and restrictive cardiomyopathy (RCM).
- Myocarditis diagnosis utilized myocardial morphology or a non-invasive algorithm including clinical data, anti-cardiac antibody (Ab) levels, and cardiac MRI.
Main Results:
- Myocarditis prevalence varied significantly across cardiomyopathies: 74.3% in ARVC, 56.7% in DCM, 54.4% in LVNC, 37.5% in RCM, and 30.9% in hypertrophic cardiomyopathy (HCM).
- Myocarditis, of viral or autoimmune origin, presented as new or worsened chronic heart failure (CHF) and arrhythmias.
- Treating myocarditis in cardiomyopathies led to stabilization or improvement and reduced adverse events.
Conclusions:
- Genetic factors and inflammation are interconnected in cardiomyopathies, creating complex phenotypes.
- Myocarditis is a crucial therapeutic target in genetic cardiomyopathies and warrants proactive diagnosis and management.
Background:
Myocardial disease is an important component of the wide field of cardiovascular disease. However, the phenomenon of multiple myocardial diseases in a single patient remains understudied.
Aim:
To investigate the prevalence and impact of myocarditis in patients with genetic cardiomyopathies and to evaluate the outcomes of myocarditis treatment in the context of cardiomyopathies.
Methods:
A total of 342 patients with primary cardiomyopathies were enrolled. The study cohort included 125 patients with left ventricular non-compaction (LVNC), 100 with primary myocardial hypertrophy syndrome, 70 with arrhythmogenic right ventricular cardiomyopathy (ARVC), 60 with dilated cardiomyopathy (DCM), and 30 with restrictive cardiomyopathy (RCM). The diagnosis of myocarditis was based on data from myocardial morphological examination or a non-invasive diagnostic algorithm consisting of an analysis of clinical presentation, anti-cardiac antibody (Ab) titres, and cardiac MRI.
Results:
The prevalence of myocarditis was 74.3% in ARVC, 56.7% in DCM, 54.4% in LVNC, 37.5% in RCM, and 30.9% in HCM. Myocarditis had a primary viral or secondary autoimmune nature and manifested with the onset or worsening of chronic heart failure (CHF) and arrhythmias. Treatment of myocarditis in cardiomyopathies has been shown to stabilise or improve patient condition and reduce the risk of adverse outcomes.
Conclusions:
In cardiomyopathies, the genetic basis and inflammation are components of a single continuum, which forms a complex phenotype. In genetic cardiomyopathies, myocarditis should be actively diagnosed and treated as it is an important therapeutic target.
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