Diagnosis and treatment of patients with virus induced inflammatory cardiomyopathy

Abstract

Chronic viral induced inflammatory cardiomyopathy causes progression of left ventricular dysfunction and is an important cause of dilated cardiomyopathy. Despite of the progress made in heart failure therapy, mortality of dilated cardiomyopathy is still 10% per year. Current heart failure therapy is symptomatic and does not impact on the specific underlying pathogenic mechanisms. Thus, specific treatment strategies that are directed against the underlying pathogenetic causes are required if myocarditis and its sequela, namely inflammatory cardiomyopathy, are to be successfully treated. Because histological and, especially, clinical diagnosis is fraught with numerous problems, an aetiological classification based on histology, immunohistochemistry and molecular biology is favourable, particularly in view of the improvements in methods made in recent years. The combination of these diagnostic techni-ques allows a new classification of dilated cardiomyo-pathy by differentiating the disease entity in subgroups of virus positive and virus negative patients with or without cardiac inflammation. This may not only contribute toward improving our understanding of underlying pathological mechanisms, but ultimately may also assist in developing specific immunomodulatory treatments. Preliminary results from ongoing treatment trials suggest that specific antiviral or anti-inflammatory treatment strategies are successful in patients who have been carefully selected and characterized according to biopsy-based diagnostic criteria.