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[Etiopathogenesis of dilated cardiomyopathies]
A S Petronio1, M T Manes, F Di Meco
1Istituto di Cardiologia, Università degli Studi, Pisa.
Insights
Viral infections and specific Major Histocompatibility Complex (MHC) patterns may contribute to dilated cardiomyopathy (DCM) development and progression. Microvascular changes are also implicated in this heart condition.
Area of Science:
- Cardiology
- Virology
- Immunogenetics
Context:
- Dilated cardiomyopathy (DCM) is a complex heart condition with unclear etiopathological origins.
- Investigating viral persistence and host immune response is crucial for understanding DCM pathogenesis.
Purpose:
- To explore viral genoma persistence (Coxsackie, HBV) in endomyocardial biopsies.
- To analyze Major Histocompatibility Complex (MHC) class II patterns in lymphocytes.
- To assess coronary microcirculation in endomyocardial and skin biopsies.
Summary:
- A 14% viral genoma positivity was detected.
- A significant predominance of DR5 (MHC class II) was observed in patients with impaired ventricular function.
- Coronary microcirculation showed dilation in 48% of patients, particularly those with severe disease.
- Viral myocarditis and MHC patterns appear to influence DCM progression, with microcirculation playing a pathophysiological role.
Impact:
- Suggests viral myocarditis and specific MHC profiles as potential factors in DCM etiopathogenesis.
- Highlights the role of microvascular dysfunction in DCM pathophysiology.
- Indicates that no single etiological hypothesis currently predominates for dilated cardiomyopathy.
Abstract:
This study was carried out on 43 patients affected by dilated cardiomyopathy to investigate some of the etiopathological hypotheses on this illness. The Authors investigated: the persistence of virus genoma (coxsackie, HBV) on endomyocardial biopsies; the pattern of the II class major histocompatibility complex (MHC) were in the blood lymphocytes; the microvascular aspect of coronary circulation in the endomyocardial biopsies. Finally, in a separated group of 19 patients, the microvascular circulation was studied on skin biopsies and correlated with diabetic, valvular and normal subject. The results showed a 14% positivity for the presence of the virus genoma and a significant predominate of DR5 in the II class MHC of patients with a worse ventricular function. Capillary vessels of the coronary microcirculation were dilated in the 48% of the patients, especially in more compromised subjects. Viral myocarditis seem to play a role in the etiopathogenesis of dilated cardiomyopathies (DCM) and the pattern of MHC could influence the progression of the illness. The microcirculation is probably a pathophysiological aspect. No etiological hypothesis seems to predominate.