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Myocarditis and inflammatory cardiomyopathy: current evidence and future directions.
Nat Rev Cardiol. 2021 03; 18(3):169-193.NR

Abstract

Inflammatory cardiomyopathy, characterized by inflammatory cell infiltration into the myocardium and a high risk of deteriorating cardiac function, has a heterogeneous aetiology. Inflammatory cardiomyopathy is predominantly mediated by viral infection, but can also be induced by bacterial, protozoal or fungal infections as well as a wide variety of toxic substances and drugs and systemic immune-mediated diseases. Despite extensive research, inflammatory cardiomyopathy complicated by left ventricular dysfunction, heart failure or arrhythmia is associated with a poor prognosis. At present, the reason why some patients recover without residual myocardial injury whereas others develop dilated cardiomyopathy is unclear. The relative roles of the pathogen, host genomics and environmental factors in disease progression and healing are still under discussion, including which viruses are active inducers and which are only bystanders. As a consequence, treatment strategies are not well established. In this Review, we summarize and evaluate the available evidence on the pathogenesis, diagnosis and treatment of myocarditis and inflammatory cardiomyopathy, with a special focus on virus-induced and virus-associated myocarditis. Furthermore, we identify knowledge gaps, appraise the available experimental models and propose future directions for the field. The current knowledge and open questions regarding the cardiovascular effects associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are also discussed. This Review is the result of scientific cooperation of members of the Heart Failure Association of the ESC, the Heart Failure Society of America and the Japanese Heart Failure Society.

Authors+Show Affiliations

Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité - University Medicine Berlin, Campus Virchow Clinic, Berlin, Germany. carsten.tschoepe@charite.de. German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany. carsten.tschoepe@charite.de. Department of Cardiology, Charité - University Medicine Berlin, Campus Virchow Klinikum, Berlin, Germany. carsten.tschoepe@charite.de.De Gasperis Cardio Center and Transplant Center, Niguarda Hospital, Milan, Italy.Winters Center for Heart Failure Research, Cardiovascular Research Institute, Baylor College of Medicine, Houston, TX, USA. Michael E. DeBakey VA Medical Center, Houston, Texas, USA.Division of Cardiology, Department of Cardiological, Thoracic and Vascular Sciences and Public Health, Centro Gallucci, University of Padova-Policlinico, Padova, Italy.Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL, USA.Department of Internal Medicine B, University Medicine Greifswald, Greifswald, Germany. German Centre for Cardiovascular Research (DZHK), partner site Greifswald, Greifswald, Germany.University of Miami, Miller School of Medicine, Miami, FL, USA.Department of Cardiology, Charité - University Medicine Berlin, Campus Benjamin Franklin, Berlin, Germany.Department of Cardiology, CARIM, Maastricht University, Maastricht, Netherlands. Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium.German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany. Cardiovascular and Metabolic Sciences, Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany. Berlin Institute of Health (BIH), Charité - University Medicine Berlin, Berlin, Germany.German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany. Department of Cardiology, Charité - University Medicine Berlin, Campus Virchow Klinikum, Berlin, Germany. Department of Internal Medicine/Cardiology, German Heart Center Berlin, Berlin, Germany.Cardiopathology, Institute for Pathology and Neuropathology, University Hospital Tübingen, Tübingen, Germany.Cardiovascular and Metabolic Sciences, Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.Department of Cardiology, Charité - University Medicine Berlin, Campus Virchow Klinikum, Berlin, Germany.Department of Cardiology, Charité - University Medicine Berlin, Campus Virchow Klinikum, Berlin, Germany.Kaufman Center for Heart Failure, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA.Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.Faculty of Medicine, University of Belgrade, Belgrade, Serbia.Berlin Institute of Health Center for Regenerative Therapies (BCRT), Charité - University Medicine Berlin, Campus Virchow Clinic, Berlin, Germany. German Centre for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

33046850

Citation

Tschöpe, Carsten, et al. "Myocarditis and Inflammatory Cardiomyopathy: Current Evidence and Future Directions." Nature Reviews. Cardiology, vol. 18, no. 3, 2021, pp. 169-193.
Tschöpe C, Ammirati E, Bozkurt B, et al. Myocarditis and inflammatory cardiomyopathy: current evidence and future directions. Nat Rev Cardiol. 2021;18(3):169-193.
Tschöpe, C., Ammirati, E., Bozkurt, B., Caforio, A. L. P., Cooper, L. T., Felix, S. B., Hare, J. M., Heidecker, B., Heymans, S., Hübner, N., Kelle, S., Klingel, K., Maatz, H., Parwani, A. S., Spillmann, F., Starling, R. C., Tsutsui, H., Seferovic, P., & Van Linthout, S. (2021). Myocarditis and inflammatory cardiomyopathy: current evidence and future directions. Nature Reviews. Cardiology, 18(3), 169-193. https://doi.org/10.1038/s41569-020-00435-x
Tschöpe C, et al. Myocarditis and Inflammatory Cardiomyopathy: Current Evidence and Future Directions. Nat Rev Cardiol. 2021;18(3):169-193. PubMed PMID: 33046850.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Myocarditis and inflammatory cardiomyopathy: current evidence and future directions. AU - Tschöpe,Carsten, AU - Ammirati,Enrico, AU - Bozkurt,Biykem, AU - Caforio,Alida L P, AU - Cooper,Leslie T, AU - Felix,Stephan B, AU - Hare,Joshua M, AU - Heidecker,Bettina, AU - Heymans,Stephane, AU - Hübner,Norbert, AU - Kelle,Sebastian, AU - Klingel,Karin, AU - Maatz,Henrike, AU - Parwani,Abdul S, AU - Spillmann,Frank, AU - Starling,Randall C, AU - Tsutsui,Hiroyuki, AU - Seferovic,Petar, AU - Van Linthout,Sophie, Y1 - 2020/10/12/ PY - 2020/08/17/accepted PY - 2020/10/14/pubmed PY - 2021/2/26/medline PY - 2020/10/13/entrez SP - 169 EP - 193 JF - Nature reviews. Cardiology JO - Nat Rev Cardiol VL - 18 IS - 3 N2 - Inflammatory cardiomyopathy, characterized by inflammatory cell infiltration into the myocardium and a high risk of deteriorating cardiac function, has a heterogeneous aetiology. Inflammatory cardiomyopathy is predominantly mediated by viral infection, but can also be induced by bacterial, protozoal or fungal infections as well as a wide variety of toxic substances and drugs and systemic immune-mediated diseases. Despite extensive research, inflammatory cardiomyopathy complicated by left ventricular dysfunction, heart failure or arrhythmia is associated with a poor prognosis. At present, the reason why some patients recover without residual myocardial injury whereas others develop dilated cardiomyopathy is unclear. The relative roles of the pathogen, host genomics and environmental factors in disease progression and healing are still under discussion, including which viruses are active inducers and which are only bystanders. As a consequence, treatment strategies are not well established. In this Review, we summarize and evaluate the available evidence on the pathogenesis, diagnosis and treatment of myocarditis and inflammatory cardiomyopathy, with a special focus on virus-induced and virus-associated myocarditis. Furthermore, we identify knowledge gaps, appraise the available experimental models and propose future directions for the field. The current knowledge and open questions regarding the cardiovascular effects associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection are also discussed. This Review is the result of scientific cooperation of members of the Heart Failure Association of the ESC, the Heart Failure Society of America and the Japanese Heart Failure Society. SN - 1759-5010 UR - https://www.unboundmedicine.com/medline/citation/33046850/Myocarditis_and_inflammatory_cardiomyopathy:_current_evidence_and_future_directions_ L2 - https://doi.org/10.1038/s41569-020-00435-x DB - PRIME DP - Unbound Medicine ER -