Prevalence and prognostic relevance of myocardial inflammation and cardiotropic viruses in non-ischemic dilated cardiomyopathy

Background: Non-ischemic dilated cardiomyopathy (DCM) is a heterogeneous disease with a spectrum of etiological factors. However, subsets of the disease are not well-characterized with respect to these factors. The aim of this study was to evaluate the prevalence of myocardial inflammation and cardiotropic viruses in DCM patients and their impact on clinical outcome. Methods: Fifty-seven patients with DCM underwent endomyocardial biopsy between 2010 and 2013. Biopsies were analyzed by polymerase chain reaction (PCR) for the presence of cardiotropic viruses, and inflammatory cell infiltration was assessed by immunohistochemistry. During a 5-year follow-up, 27 (47%) patients reached the primary composite outcome measure: heart transplantation, left ventricle assist device implantation or cardiovascular-related death. Results: rvovirus B19 and human herpesvirus type-6. Four specific sub-groups were distinguished by PCR and immunohistochemistry: virus-positive (chronic) myocarditis, autoreactive inflammatory DCM, viral DCM, non-inflammatory DCM. The presence of a viral genome in myocardium or diagnosis of inflammatory DCM did not predict the outcome of composite outcome measures (p > 0.05). However, univariate Cox regression and survival function estimation revealed an association between inflammation by a high number of T-cells and poor prognosis. Conclusions: This study has shown that two markers — cardiotropic viruses and myocardial inflammation — are prevalent among DCM patients. They are also helpful in identifying sub-groups of DCM. An increased number of T-lymphocytes in the myocardium is a predictor of poor mid-term and long‐term prognosis

Uždegiminė diliatacinė kardiomiopatija: naUji diagnostikos ir gydymo būdai inflammatory dilated cardiomyopathy: new perspective in diagnostics and treatment

1 Vilniaus universiteto Medicinos fakulteto Patologijos, teismo medicinos ir farmakologijos katedra 2 Vilniaus universiteto Medicinos fakulteto Širdies ir kraujagyslių ligų klinika santraUka Reikšminiai žodžiai: uždegiminė diliatacinė kardiomiopatija, širdies nepakankamumas, etiologija, gydymas. Neišeminės kilmės, uždegiminė diliatacinė kardiomiopatija (uDKMP) yra viena svarbiausių širdies nepakankamumo ir šir-dies transplantacijų priežasčių. Širdies raumuo gali būti organas -taikinys virusinei, bakterinei, pirmuonių ar parazitinei infekcijai, tačiau taip pat gali nukentėti ir netiesiogiai, dėl infekcinių organizmų ir kryžminio antikūnų poveikio. Kliniškai miokarditas ir uždegiminė kardiomiopatija gali pasireikšti daugybe simptomų -nuo asimptominės eigos iki miokardo infarkto ar net sunkaus kardiogeninio šoko. Tokie pacientai gali spontaniškai pasveikti, tačiau dažniausiai jiems pamažu progresuoja širdies nepakankamumas ir tenka transplantuoti širdį. Pastarojo meto diliatacinės kardiomiopatijos etiologijos tyrimai parodė, kad pagrindinės šios ligos priežastys yra virusinė infekcija, genetiniai sutrikimai ir autoimuniniai mechanizmai. Nors buvo pasiekta didelė pažanga gydant širdies nepakankamumą kaip kardiomiopatijos pasekmę, vis dar nemažėja pacientų su gydymui atspariu širdies nepakankamumu, o jų būklė negerėja nepaisant viso prieinamo gydymo. Siekdami pademonstruoti šiuolaikines uDKMP diagnostines ir etiopatogenetinio gydymo galimybes, pateikiame du klinikinius atvejus ir trumpą literatūros apžvalgą. abstract Key words: Myocarditis; Inflammatory cardiomyopathy; Heart Failure; Endomyocardial Biopsy, Virus genome; Aetiologydirected treatment. Non-ischemic, inflammatory dilated cardiomyopathy (iCMP) is an important cause of heart failure and heart transplantation. The heart can be the primary target of a viral, bacterial, protozoic or parasitic infection or it could be involved in the "collateral damage" of infective organisms and cross-reactive antibodies. Clinical manifestation of myocarditis or inflammatory cardiomyopathy varies, with a broad spectrum of symptoms ranging from asymptomatic courses over presentations with signs of myocardial infarction to devastating illness with cardiogenic shock. The affected patients may recover or develop dilated cardiomyopathy with heart failure and the need for heart transplantation. The recent progress in study on etiology of dilative cardiomyopathy has shown that viral infection, genetic abnormalities and autoimmune mechanisms are major causes of this disease. Although significant progress has been achieved in the treatment of heart failure as a result of cardiomyopathy, it is a still matter of fact that there are many patients with refractory heart failure who do not respond despite every available treatment. Presently, feasible clinical pathways are available, which can lead to a correct diagnosis and specific treatment. Two cases are presented to illustrate the possibilities of the diagnosis of distinct iCMP subentities and aetiology-directed treatment strategies. Dainius Daunoravičiu