Abstract
Myocarditis is a non-ischemic inflammatory disease of the myocardium associated with cardiac dysfunction. It most often results from infectious agents, hypersensitivity responses, or immune-related injury. In spite of the development of various diagnostic modalities, early and definite diagnosis of myocarditis still depends on the detection of inflammatory infiltrates in endomyocardial biopsy specimens according to Dallas criteria. Routine application of immunohistochemistry (for characterization of inflammatory cell infiltration) and Polymerase Chain Reaction PCR analysis (for identification of infective agents) has become an essential part of the diagnostic armamentarium for a more precise biopsy report. A new morphological classification is advanced to overcome the limits of Dallas criteria. A semiquantitative assessment of myocyte damage/inflammation (grading) as well as of fibrosis (staging) is indicated, thus providing histopathological diagnosis useful to the clinician for more appropriate patient risk stratification and for the application of new therapies. Consequently, the final diagnosis of myocarditis should be mainly based on three features: etiology, grade, and stage of the disease.
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References
Angelini A, Crosato M, Boffa GM, et al. (2002) Active versus borderline myocarditis: clinicopathological correlates and prognostic implications. Heart 87:210–215
Aretz HT (1987) Myocarditis: the Dallas Criteria. Hum Pathol 18:619–624
Billingham ME (1989) Acute myocarditis: is sampling error a contraindication for diagnostic biopsies? J Am Coll Cardiol 14:921–922
Billingham ME (1990) Dilemma of variety of histopathologic grading systems for acute cardiac allograft rejection by endomyocardial biopsy. J Heart Transplant 9:272–276
Burke AP, Farb A, Robinowitz M, Virmani R (1991) Serial sectioning and multiple level examination of endomyocardial biopsies for the diagnosis of myocarditis. Mod Pathol 4:690–693
Calabrese F, Thiene G (2003) Myocarditis and inflammatory cardiomyopathy: microbiological andmolecular biological aspects. Cardiovasc Res 60:11–25
Calabrese F, Valente M, Thiene G, et al. (1999) Enteroviral genome in native hearts may influence outcome of patients who undergo cardiac transplantation. Diagn Mol Pathol 8:39–46
Calabrese F, Rigo E, Milanesi O, et al. (2002) Molecular diagnosis of myocarditis and dilated cardiomyopathy in children. Clinico-pathologic features and prognostic implications. Diagn Mol Pathol 11:212–221
Chapman NM, Tracy S, Gauntt CJ, Fortmueller U (1990) Molecular detection and identification of enteroviruses using enzymatic amplification and nucleic acid hybridization. J Clin Microbiol 28:843–850
Chimenti C, Calabrese F, Thiene G, et al. (2001) Inflammatory left ventricular microaneurysms as a cause of apparently idiopathic ventricular tachyarrhythmias. Circulation 104:168–173
Chow LH, Radio SJ, Sears TD, McManus BM (1989) Insensitivity of right ventricular endomyocardial biopsy in the diagnosis of myocarditis. J Am Coll Cardiol 14:915–920
Desmet VJ, Gerber M, Hoofnagle JH, Manns M, Scheuer PJ (1994) Classification of chronic hepatitis: diagnosis, grading and staging. Hepatology 19:1513–1520
Edwards WD (1984) Myocarditis and endomyocardial biopsy. Cardiol Clin 2:647–656
Edwards WD (1985) Current problems in establishing quantitative histopathologic criteria for the diagnosis of lymphocytic myocarditis by endomyocardial biopsy. Heart Vessels 1:138–142
Edwards WD, Holmes DR, Reeders GS (1982) Diagnosis of active lymphocytic myocarditis by endomyocardial biopsy: quantitative criteria for light microscopy. Mayo Clin Proc 57:419–425
Frustaci A, Bellocci F, Olsen EG (1994) Results of biventricular endomyocardial biopsy in survivors of cardiac arrest with apparently normal hearts. Am J Cardiol 74:890–895
Grasso M, Arbustini E, Silini E, et al. (1992) Search for coxsackievirus B3 RNA in idiopathic dilated cardiomyopathy using gene amplification by polymerase chain reaction. Am J Cardiol 69:658–664
Hauck AJ, Edwards ED (1992) Histopathologic examination of tissues obtained by endomyocardial biopsy. In: Fowles RE (ed) Cardiac biopsy. Futura, Mount Kisco, pp 95–153
Hauck AJ, Kearney DL, Edwards WD (1989) Evaluation of postmortem endomyocardial biopsy specimens from 38 patients with lymphocytic myocarditis: implications for role of sampling error. Mayo Clin Proc 64:1235–1245
Herskowitz A, Ahmed-Ansari A, Neumann DA, et al. (1990) Induction of major histocompatibility complex antigens within the myocardium of patients with active myocarditis: a nonhistologic marker of myocarditis. J Am Coll Cardiol 15:624–632
Hilton DA, Variend S, Pringle JH (1993) Demonstration of coxsackie virus RNA in formalin-fixed tissue sections from childhood myocarditis cases by in situ hybridization and the polymerase chain reaction. J Pathol 170:45–51
Jin O, Sole MJ, Butany JW, et al. (1990) Detection of enterovirus RNA in myocardial biopsies from patients with myocarditis and cardiomyopathy using gene amplification by polymerase chain reaction. Circulation 82:8–16
Kuhl U, Seeberg B, Schultheiss HP, Strauer BE (1994) Immunohistological characterization of infiltrating lymphocytes in biopsies of patients with clinically suspected dilated cardiomyopathy. Eur Heart J 15:62–67
Kuhl U, Noutsias M, Schultheiss HP (1995) Immunohistochemistry in dilated cardiomyopathy. Eur Heart J 16:100–106
Kuhl U, Noutsias M, Seeber B, Shultheiss HP (1996) Immunohistological evidence for a chronic intramyocardial inflammatory process in dilated cardiomyopathy. Heart 75:295–300
Kuhl U, Pauschinger M, Noutsias M, et al. (2005) High prevalence of viral genomes and multiple viral infections in the myocardium of adults with “idiopathic” left ventricular dysfunction. Circulation 111:887–893
Linder J, Cassling RS, Rogler WC, et al. (1985) Immunohistochemical characterization of lymphocytes in uninflamed ventricular myocardium. Implications for myocarditis. Arch Pathol Lab Med 109:917–920
Maisch B, Bultmann B, Factor S, et al. (1998) Dilated cardiomyopathy with inflammation or chronic myocarditis: variability and consensus in the diagnosis. Eur Heart J 19:647 (abs)
Martin AB, Webber S, Fricker FJ, et al. (1994) Acute myocarditis. Rapid diagnosis by PCR in children. Circulation 90:330–339
Pauschinger M, Bowles NE, Fuentes-Garcia FJ, et al. (1999) Detection of adenoviral genome in the myocardium of adult patients with idiopathic left ventricular dysfunction. Circulation 99:1348–1354
Petitjean J, Kopecka H, Freymuth F, et al. (1992) Detection of enterovirus in endomyocardial biopsy by molecular approach. J Med Virol 37:76–82
Richardson P, McKenna WJ, Bristow M, et al. (1996) Report of the 1995 WHO/ISFC task force on the definition of cardiomyopathies. Circulation 93:841–842
Schnitt SJ, Ciano PS, Schoen FJ (1987) Quantitation of lymphocytes in endomyocardial biopsies: use and limitations of antibodies to leukocyte common antigen. Hum Pathol 18:796–800
Tazelaar HD, Billingham ME (1987) Myocardial lymphocytes. Fact, fancy or myocarditis? Am J Cardiovasc Pathol 1:47–50
Thiene G, Bartoloni G, Poletti A, Boffa GM (1996) Tecniche, indicazioni ed utilità della biopsia endomiocardica. In: Baroldi G, Thiene G (eds) Biopsia endomiocardica — Testo atlante. Edizioni Piccin, Padova, pp 5–45
Vitali C, Bombardieri S, Moutsopoulos HM, et al. (1993) Preliminary criteria for the classification of Sjogren’s syndrome. Results of a prospective concerted action supported by the European Community. Arthritis Rheum 36:340–347
Weiss LM, Liu XF, Chang KL, Billingham ME (1992) Detection of enteroviral RNA in idiopathic dilated cardiomyopathy and other human cardiac tissues. J Clin Invest 90:156–159
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Calabrese, F., Angelini, A., Carturan, E., Thiene, G. (2006). Myocarditis and Inflammatory Cardiomyopathy: Histomorphological Diagnosis. In: Schultheiss, H.P., Kapp, J.F., Grötzbach, G. (eds) Chronic Viral and Inflammatory Cardiomyopathy. Ernst Schering Research Foundation Workshop, vol 55. Springer, Berlin, Heidelberg . https://doi.org/10.1007/3-540-30822-9_17
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DOI: https://doi.org/10.1007/3-540-30822-9_17
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