Myokarditiden und entzündliche Kardiomyopathien sind erworbene Erkrankungen des Herzmuskels, die durch zahlreiche infektiöse und nicht infektiöse Ursachen ausgelöst werden können. Für die differenzialdiagnostische Abklärung der Erkrankungsursache und sich daraus ableitender spezifischer Behandlungsstrategien ist eine eindeutige Diagnosesicherung notwendig. Erst die Biopsiediagnostik ermöglicht es, die zugrunde liegenden spezifischen Pathomechanismen exakt zu erfassen und die Basis für neue Behandlungsstrategien mit günstiger Beeinflussung der Erkrankungsverläufe zu schaffen. Obwohl die bisherigen Studien zeigen, dass entzündlich oder viral induzierte chronische Kardiomyopathien prinzipiell von spezifischen Behandlungsansätzen profitieren, müssen die optimalen Behandlungszeitpunkte und Behandlungsstrategien durch weitere randomisierte Untersuchungen an größeren, exakt charakterisierten Patientengruppen verifiziert werden, bevor allgemein geltende Behandlungsempfehlungen gegeben werden können.
In?ammatory cardiomyopathy is an acute or chronic cardiac muscle disease caused by a myocardial in?ltration of immunocompetent cells following any kind of cardiac injury. Acute myocarditis is often a result of a viral infection that produces myocardial necrosis and triggers an immune response aiming at elimination of the infectious agent. Chronic myocardial injury may furthermore develop by postinfectious immune or autoimmune processes or be associated with systemic autoimmune diseases which, in the long run, are responsible for persistent or progressive ventricular dysfunction, arrhythmias and cardiac complaints. If the underlying infectious or immune-mediated causes of the disease are carefully defined by clinical and biopsy-based tools, specific immunosuppressive and antiviral treatment options, in addition to basic symptomatic therapy, may improve prognosis in a number of patients with acute and chronic inflammatory and infectious heart diseases.
Key words
In?ammatory cardiomyopathy - myocarditis - viral infection - arrhythmia - biopsy-based tools - immunosuppressive and antiviral treatment
Literatur
-
1
Aretz HT.
Myocarditis: the Dallas criteria.
Hum Pathol.
1987;
18
619-624
-
2
Richardson P, McKenna W, Bristow M et al..
Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of cardiomyopathies [news].
Circulation.
1996;
93
841-842
-
3 Liu PP, Schultheiss HP. Myocarditis. In: Baunwald, ed Heart Disease. Philadelphia: W B Saunders co; 2008. 8: 1775-1792
-
4
Kuhl U, Pauschinger M, Noutsias M et al..
High prevalence of viral genomes and multiple viral infections in the myocardium of adults with „idiopathic“ left ventricular dysfunction.
Circulation.
2005;
111
887-893
-
5
Kuhl U, Pauschinger M, Seeberg B et al..
Viral persistence in the myocardium is associated with progressive cardiac dysfunction.
Circulation.
2005;
112
1965-1970
-
6
Baboonian C, Treasure T.
Meta-analysis of the association of enteroviruses with human heart disease.
Heart.
1997;
78
539-543
-
7
Kuhl U, Schultheiss HP.
Viral myocarditis: diagnosis, aetiology and management.
Drugs.
2009;
69
1287-1302
-
8
Mason JW, O'Connell JB, Herskowitz A et al..
A clinical trial of immunosuppressive therapy for myocarditis. The Myocarditis Treatment Trial Investigators.
[see comments]
N Engl J Med.
1995;
333
269-275
-
9
Cooper L, Hare JM, Tazelaar HD et al..
Usefulness of Immunosuppression for Giant Cell Myocarditis.
Am J Cardiol.
2008;
102
1535-1539
-
10
Why HJ, Meany BT, Richardson PJ et al..
Clinical and prognostic significance of detection of enteroviral RNA in the myocardium of patients with myocarditis or dilated cardiomyopathy.
Circulation.
1994;
89
2582-2589
-
11
Frustaci A, Chimenti C, Calabrese F et al..
Immunosuppressive therapy for active lymphocytic myocarditis: virological and immunologic profile of responders versus nonresponders.
Circulation.
2003;
107
857-863
-
12
Mangnani JW, Dec GW.
Myocarditis: Current Trends in Diagnosis and Treatment.
Circulation.
2006;
113
876-890
-
13
Stanton C, Mookadam F, Cha S et al..
Greater symptom duration predicts response to immunomodulatory therapy in dilated cardiomyopathy.
Int J Cardiol.
2008;
128
38-41
-
14
Cooper Jr. LT, Berry GJ, Rizeq M, Schroeder JS.
Giant cell myocarditis.
J Heart Lung Transplant.
1995;
14
394-401
-
15
Kühl U, Strauer BE, Schultheiss HP.
Methylprednisolone in chronic myocarditis.
Postgrad Med J.
1994;
70
35-42
-
16
Wojnicz R, Nowalany-Kozielska E, Wojciechowska C et al..
Randomized, placebo-controlled study for immunosuppressive treatment of inflammatory dilated cardiomyopathy: two-year follow-up results.
Circulation.
2001;
104
39-45
-
17
Frustaci A, Russo MA, Chimenti C.
Randomized study on the efficacy of immunosuppressive therapy in patients with virus-negative inflammatory cardiomyopathy: the TIMIC study.
Eur Heart J.
2009;
30
1995-2002
-
18
Kuhl U, Pauschinger M, Schwimmbeck PL et al..
Interferon-beta treatment eliminates cardiotropic viruses and improves left ventricular function in patients with myocardial persistence of viral genomes and left ventricular dysfunction.
Circulation.
2003;
107
2793-2798
-
19
Schultheiss HP, Piper C, Sowade K et al..
The effect of subcutaneous treatment with interferon-beta-1b over 24 weeks on safety, virus elimination and clinical outcome in patients with chronic viral cardiomyopathy.
Circulation.
Abstract
2008;
-
20
Schmidt-Lucke C, Spillmann F, Bock T et al..
Interferon-beta modulates endothelial damage in patients with cardiac persistance of parvovirus B19V.
J Infectious Dis.
2010;
201
936-945
Korrespondenz
Dr. Uwe Kühl
Medizinische Klinik II, Kardiologie und Pulmologie Charité – Universitätsmedizin Berlin Campus Benjamin Franklin
Hindenburgdamm 30
12200 Berlin
Fax: 030/8445-4219
eMail: uwe.kuehl@charite.de
