Heart Failure Reviews

, Volume 18, Issue 6, pp 715–732

Immune-mediated and autoimmune myocarditis: clinical presentation, diagnosis and management

  • Alida L. P. Caforio
  • Renzo Marcolongo
  • Roland Jahns
  • Michael Fu
  • Stephan B. Felix
  • S. Iliceto
Article

DOI: 10.1007/s10741-012-9364-5

Cite this article as:
Caforio, A.L.P., Marcolongo, R., Jahns, R. et al. Heart Fail Rev (2013) 18: 715. doi:10.1007/s10741-012-9364-5

Abstract

According to the current WHO classification of cardiomyopathies, myocarditis is an inflammatory disease of the myocardium and is diagnosed by endomyocardial biopsy using established histological, immunological and immunohistochemical criteria; it may be idiopathic, infectious or autoimmune and may heal or lead to dilated cardiomyopathy (DCM). DCM is characterized by dilatation and impaired contraction of the left or both ventricles; it may be idiopathic, familial/genetic, viral and/or immune. The diagnosis of DCM requires exclusion of known, specific causes of heart failure, including coronary artery disease. On endomyocardial biopsy, there is myocyte loss, compensatory hypertrophy, fibrous tissue and immunohistochemical findings consistent with chronic inflammation (myocarditis) in 30–40 % of cases. In a patient subset, myocarditis and DCM represent the acute and chronic stages of an inflammatory disease of the myocardium, which can be viral, post-infectious immune or primarily organ-specific autoimmune. Here, we review the clinical presentation, etiopathogenetic diagnostic criteria, and management of immune-mediated and autoimmune myocarditis.

Keywords

Myocarditis Inflammatory cardiomyopathies Dilated cardiomyopathy Cardiac autoantibodies Autoimmunity 

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Alida L. P. Caforio
    • 1
  • Renzo Marcolongo
    • 2
  • Roland Jahns
    • 3
  • Michael Fu
    • 4
  • Stephan B. Felix
    • 5
  • S. Iliceto
    • 1
  1. 1.Division of Cardiology, Department of Cardiological, Thoracic and Vascular Sciences, Centro “V. Gallucci”University of Padova-PoliclinicoPaduaItaly
  2. 2.Haematology and Clinical Immunology, Department of MedicineUniversity of PaduaPaduaItaly
  3. 3.Comprehensive Heart Failure Center (CFHC)University Hospital WürzburgWürzburgGermany
  4. 4.Department of Medicine, Heart Failure UnitSahlgrenska University Hospital, University of GöteborgGöteborgSweden
  5. 5.Klinik Fur Innere Medizin BUniversity of GreifswaldGreifswaldGermany