nach oben

Erschienen in:

27.04.2017 | CME

Inflammatorische Kardiomyopathie und Myokarditis

verfasst von: Prof. Dr. B. Maisch, Prof. A. D. Ristic, Prof. Dr. S. Pankuweit

Erschienen in: Herz | Ausgabe 4/2017

Einloggen, um Zugang zu erhalten

Zusammenfassung

In diesem Beitrag werden Diagnostik, Differenzialdiagnostik, multimodale Bildgebung sowie medikamentöse und invasiv diagnostische Therapie der inflammatorischen Kardiomyopathie und Myokarditis unter ätiologischen Gesichtspunkten und in Anlehnung und Fortentwicklung des Positionspapiers der Working Group Myocardial and Pericardial Disease der European Society of Cardiology beschrieben. Im Vordergrund der Diagnostik steht die ätiopathogenetische Einordnung der inflammatorischen Kardiomyopathie, die klinisches Bild, Verlauf, Therapie und Prognose prägen. Die virale Myokarditis wird von der sterilen autoreaktiven (autoimmunen) Form durch histologische und molekulare Untersuchungen in der Myokardbiopsie abgegrenzt. Dies führt zu einer individualisierten, ätiologisch fundierten und gezielten Behandlung jenseits einer reinen Herzinsuffizienzbehandlung.

Caforio AL, Pankuweit S, Arbustini E et al (2013) Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J 34(33):2636–2648CrossRefPubMed

Richardson P, McKenna W, Bristow M et al (1996) Report of the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of cardiomyopathies. Circulation 93:841–842CrossRefPubMed

Elliott P, Andersson B, Arbustini E et al (2007) Classification of the cardiomyopathies: a position statement from the European Society of Cardiology working group on myocardial and pericardial disease. Eur Heart J 29:270–276CrossRefPubMed

Maron BJ, Towbin JA, Thiene G et al (2006) Contemporary definitions and classification of cardiomyopathies. An American Heart Association scientific statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcome Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups and Council on Epidemiology and Prevention. Circulation 113:1807–1816CrossRefPubMed

Maisch B, Bültmann B, Factor S et al (1999) World Heart Federation consensus conferences’s definition of inflammatory cardiomyopathy (myocarditis): report from two expert committees on histology and viral cardiomyopathy. Heartbeat 4:3–4

Maisch B, Pankuweit S (2012) Current treatment options in (peri)myocarditis and inflammatory cardiomyopathy. Herz 37(6):644–656CrossRefPubMed

Maisch B, Pankuweit S (2013) Standard and etiology-directed evidence-based therapies in myocarditis: state of the art and future perspectives. Heart Fail Rev 18(6):761–795CrossRefPubMed

Aretz HT, Billingham M, Edwards WD et al (1985) Myocarditis: a histopathologic definition and classification. Am J Cardiovasc Pathol 1:1–10

Leone O, Veinot JP, Angelini A et al (2012) 2011 Consensus statement on endomyocardial biopsy from the Association for European Cardiovascular Pathology and the Society for Cardiovascular Pathology. Cardiovasc Pathol 21:245–274CrossRefPubMed

10.

Gore I, Saphir O (1947) Myocarditis; a classification of 1402 cases. Am Heart J 34:827–830CrossRefPubMed

11.

Basso C, Calabrese F, Corrado D, Thiene G (2001) Postmortem diagnosis of sudden cardiac death victims. Cardiovasc Res 50:290–300CrossRefPubMed

12.

Towbin JA, Lowe AM, Colan SD et al (2006) Incidence, causes, and outcomes of dilated cardiomyopathy in children. JAMA 296:1867–1876CrossRefPubMed

13.

Pankuweit S, Maisch B (2012) Ätiologie, Diagnose, Management und Therapie der Myokarditis. Positionspapier der ESC Working Group on Myocardial and Pericardial Diseases. Herz 38:855–861CrossRef

14.

Johnson DB, Balko JM, Compton ML et al (2016) Fulminant myocarditis with combination immune checkpoint blockade. N Engl J Med 375:1749–1755CrossRefPubMedPubMedCentral

15.

Blauwet LA, Cooper LT (2014) Idiopathic giant cell myocarditis and cardiac sarcoidosis. Heart Fail Rev 18:733–746CrossRef

16.

Maisch B, Ruppert V, Pankuweit S (2014) Management of fulminant myocarditis: a diagnosis in search of its etiology but with therapeutic options. Curr Heart Fail Rep 11(2):166–177CrossRefPubMed

17.

Friedrich MG, Sechtem U, Schulz-Menger J et al (2009) International Consensus Group on Cardiovascular Magnetic Resonance in Myocarditis. Cardiovascular magnetic resonance in myocarditis: a JACC White Paper. J Am Coll Cardiol 53:1475–1487CrossRefPubMedPubMedCentral

18.

Mahrholdt H, Goedecke C, Wagner A et al (2004) Cardiovascular magnetic resonance assessment of human myocarditis: a comparison to histology and molecular pathology. Circulation 109:1250–1258CrossRefPubMed

19.

Alter P, Rupp H, Adams P et al (2011) Occurrenceof late gadolinium enhancement is associated with increase left ventricular wall stress and mass in patients with non-ischaemic dilated cardiomyopathy. Eur J Heart Fail 13:937–944CrossRefPubMed

20.

Schulz-Menger J, Maisch B, Abdel-ATy H, Pankuweit S (2007) Integrated biomarkers in cardiomyopathies: cardiovascular magnetic resonance imaging combined with molecular and immunologic markers. A stepwise approach for diagnosis and treatment. Herz 32:458–472CrossRefPubMed

21.

Mahfoud F, Gärtner B, Kindermann M et al (2011) Virus serology in patients with supected myocarditis: utility or futility? Eur Heart J 32:897–903CrossRefPubMed

22.

Cooper LT, Baughman KL, Feldman AM, American Heart Association American College of Cardiology European Society of Cardiology et al (2007) The role of endomyocardial biopsy in the management of cardiovascular disease: a scientific statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology. Circulation 116:2216–2233CrossRefPubMed

23.

Besler C, Urban D, Watzka S et al (2016) Endomyocardial miR-133a levels correlate with myocardial inflammation, improved left ventricular function, and clinical outcome in patients with inflammatory cardiomyopathy. Eur J Heart Fail 18:1442–1451CrossRefPubMed

24.

Pankuweit S, Moll R, Baandrup U et al (2003) Prevalence of the parvovirus B19 genome in endomyocardial biopsy specimens. Hum Pathol 34:497–503CrossRefPubMed

25.

Kühl U, Pauschinger M, Noutsias M, Schultheiss H‑P (2005) High prevalence of viral genomes and multiple viral infections in the myocardium of adults with „idiopathic“ left ventricular dysfunction. Circulation 11:887–893CrossRef

26.

Verdonschot J, Hazebroek M, Merken J et al (2016) Relevance of cardiac parvobirus B19 in myocarditis and dilated cardiomyopathy: review of the literature. Eur J Heart Fail 18:1430–1441. doi:10.1002/ejhf.665 CrossRefPubMed

27.

Heidecker B, Kittleson MM, Kasper EKG et al (2011) Transcriptomic biomarkers for accurate diagnosis of myocarditis. Circulation 123:1174–1184CrossRefPubMedPubMedCentral

28.

Ruppert V, Maisch B (2012) Molecular signatures and the study of gene expression profiles in inflammatory heart disease. Herz 37:619–626CrossRefPubMed

29.

Basso C, Carturan E, Corrado D, Thiene G (2007) Myocarditis and dilated cardiomyopathy in athletes: diagnosis, management and recommendations for sport activity. Cardiol Clin 25:423–429CrossRefPubMed

30.

Pelliccia A, Fagard R, Bjørnstad HH et al (2005) Recommendations for competitive sports participation in athletes with cardiovascular disease: a consensus document from the Study Group of Sports Cardiology of the Working Group of Cardiac Rehabilitation and Exercise Physiology and the Working Group of Myocardial and Pericardial Diseases of the European Society of Cardiology. Eur Heart J 26:1422–1445CrossRefPubMed

31.

Weintraub RG, Semsarian C, Macdonald P (2017) Dilated cardiomyopathy. Lancet. doi:10.1016/S0140-6736(16)31713-5 PubMedCentral

32.

Maisch B, Seferovic PM, Ristic AD et al (2004) Guidelines on the diagnosis and management of pericardial diseases, executive summary. The Task Force on the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology. Eur Heart J 25:587–610CrossRefPubMed

33.

Adler Y, Charron P, Imazio M et al (2015) 2015 ESC Guidelines for the diagnosis and management of pericardial diseases. Eur Heart J 36:2921–2961CrossRefPubMed

34.

Parillo JE, Cunnion RE, Epstein SE et al (1989) A prospective, randomized controlled trial of prednisone for dilated cardiomyopathy. N Engl J Med 321:1061–1068CrossRef

35.

Frustaci A, Chimenti C, Calabrese F et al (2003) Immunosuppressive therapy for active lymphocytic myocarditis: virological and immunologic profile of responders versus nonresponders. Circulation 107:857–863CrossRefPubMed

36.

Wojnicz R, Nowalany-Kozielska E, Wojciechowska C et al (2001) Randomized, placebo controlled study for immunosuppressive treatment of inflammatory dilated cardiomyopathy. Two-year follow-up results. Circulation 104:39–45CrossRefPubMed

37.

Frustaci A, Russo MA, Chimenti C (2009) Randomized study on the efficacy of immunosuppressive therapy in patients with virus-negative inflammatory cardiomyopathy: the TIMIC study. Eur Heart J 30:1995–2002CrossRefPubMed

38.

Escher F, Kühl U, Lassner D, Poller W et al (2016) Long-term outcome of patients with virus-negativ chronic myocarditis or inflammatory cadiomyopathy after immunosuppressive therapy. Clin Res Cardiol 105:1011–1020CrossRefPubMed

39.

Maisch B, Kölsch S, Hufnagel G, for the ESETCID Investigators et al (2011) Abstract 109. AHA Congress, Orlando.

40.

Mason JW, O’Connell JB, Herskowitz A et al (1995) A clinical trial of immunosuppressive therapy for myocarditis. The Myocarditis Treatment Trial Investigators. N Engl J Med 333:269–275CrossRefPubMed

41.

Maisch B, Camerini F, Schultheiss H‑P (1955) Immunosuppressive therapy for myocarditis (letter). N Engl J Med 333:1713

42.

Cooper LT Jr, Menon S, Deng M et al (2008) Usefulness of immunosuppression for giant cell myocarditis. Am J Cardiol 102:1535–1539CrossRefPubMedPubMedCentral

43.

Edwards WD, Holmes DR, Reeder GS (1982) Diagnosis of active lymphocytic myocarditis by endomyocardial biopsy. Quantitative criteria for light microscopy. Mayo Clin Proc 57:419–425PubMed

44.

Fenoglio JJ, Ursell PC, Kellogg CF et al (1983) Diagnosis and classification of myocarditis by endomyocardial biopsy. N Engl J Med 308:12–18CrossRefPubMed

45.

Latham RD, Mulrow JP, Virmani R et al (1989) Recently diagnosed idiopathic dilated cardiomyopathy: incidence of myocarditis and efficacy of prednisone therapy. Am Heart J 117:876–882CrossRefPubMed

46.

Maisch B, Schoenian U, Hengstenberg C et al (1994) Immunosuppressive therapy in autoreactive myocarditis: results from a controlled trial. Postgrad Med J 70(Suppl 1):S29–S34PubMed

47.

Kühl U, Strauer BE, Schultheiss H‑P (1994) Methylprednisolone in chronic myocarditis. Postgrad Med J 70(Suppl 1):S35–S42

48.

Camargo PR, Snitcowsky R, da Luz PL et al (1995) Favorable effects of immunosuppressive therapy in children with dilated cardiomyopathy and active myocarditis. Pediatr Cardiol 6:61–68CrossRef

49.

Drucker NA, Colan SD, Lewis AB et al (1994) Gamma-globulin treatment of acute myocarditis in the pediatric population. Circulation 89:252–257CrossRefPubMed

50.

McNamara DM, Rosenblum WD, Janosko KM et al (1997) Intravenous immune gobulin in the therapy of myocarditis and acute cardiomyopathy. Circulation 95:2476–2478CrossRefPubMed

51.

McNamara DM, Holubkov R, Starling RC, for the Intervention in Myocarditis and Acute Cardiomyopathy (IMAC) Investigators, - (2001) Controlled trial of intravenous immune globuline in recent-onset dilated cardiomyopathy. Circulation 103:2254–2259CrossRefPubMed

52.

Kishimoto C, Shioji K, Kinoshita M et al (2003) Treatment of acute inflammatory cardiomyopathy with intravenous immunoglobulin ameliorates left ventricular function associated with suppression of inflammatory cytokines and decreased oxidative stress. Int J Cardiol 91:173–178CrossRefPubMed

53.

Dennert R, Velthuis S, Schalla S et al (2010) Intravenous immunoglobulin therapy for patients with idiopathic cardiomyoapthy and endomyocardial biopsy-proven high PVB19 viral load. Antivir Ther (Lond) 15:193–201CrossRef

54.

Maisch B, Pankuweit S, Funck R, Koelsch S (2004) Effective CMV hyperimmunoglobulin treatment in CMV myocarditis – A controlled treatment trial. Eur Heart J 114(Abstract Suppl):P674

55.

Ohlow M‑A, Brunelli M, Schreiber M, Lauer B (2016) Therapeutic effect of immunoadsorption and subsequent immunoglobulin substitution in patients with dilated cardiomypathy: results from the observational prospective Bad Berka Registry. J Cardiol 69:409–416CrossRefPubMed

56.

Kühl U, Pauschinger M, Schwimmbeck PL et al (2003) Interferon-beta treatment eliminates cardiotropic viruses and improves left ventriclar function in patients with myocardial persistence of viral genomes and left ventricular dysfunction. Circulation 107:2793–2798CrossRefPubMed

57.

Schultheiss H‑P, Piper C, Sowade O et al (2016) Betaferon in chronic viral cardiomyopathy(BICC) trial: effects of interferon-ß treatment in patients with chronic viral cardiomyopathy. Clin Res Cardiol 105:763–773CrossRefPubMed

Titel: Inflammatorische Kardiomyopathie und Myokarditis
verfasst von: Prof. Dr. B. Maisch
Prof. A. D. Ristic
Prof. Dr. S. Pankuweit
Publikationsdatum: 27.04.2017
Verlag: Springer Medizin
Erschienen in: Herz / Ausgabe 4/2017
Print ISSN: 0340-9937
Elektronische ISSN: 1615-6692
DOI: https://doi.org/10.1007/s00059-017-4569-y

Neu im Fachgebiet Kardiologie

25.04.2024 | Hypotonie | Nachrichten

Update Kardiologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Inflammatorische Kardiomyopathie und Myokarditis

Zusammenfassung

Neu im Fachgebiet Kardiologie

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

Adipositas-Medikament auch gegen Schlafapnoe wirksam

Komplette Revaskularisation bei Infarkt: Neue Studie setzt ein Fragezeichen

Update Kardiologie

Springer Medizin

Zusammenfassung

Bitte loggen Sie sich ein, um Zugang zu diesem Inhalt zu erhalten

Weitere Artikel der Ausgabe 4/2017

Elektrische Isolation des linken Vorhofohrs

Rise in BNP despite appropriate acute decompensated heart failure treatment

Posterior wall as atypical localization of left atrial myxoma

Neue Strategien für die Ablation von Vorhofflimmern

Katheterablation von persistierendem VHF – eine Herausforderung

Pulmonalvenenisolation bei Vorhofflimmern

Neu im Fachgebiet Kardiologie

Niedriger diastolischer Blutdruck erhöht Risiko für schwere kardiovaskuläre Komplikationen

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

Adipositas-Medikament auch gegen Schlafapnoe wirksam

Komplette Revaskularisation bei Infarkt: Neue Studie setzt ein Fragezeichen

Update Kardiologie