Inflammatory Cardiomyopathy: Diagnostic and Therapeutical Options
Strategies for immunosuppressive treatment of chronic inflammatory myocardial diseases are still a controversial issue. This dilemma is still unresolved despite the “American Myocarditis Trial ” which, as many other studies before, could not demonstrate any positive therapeutic effects of the immunosuppressive therapy . This, however, is not due to a general unresponsiveness of cardiac inflammation to immunosuppressive therapy, but rather reflects an inappropriate study design, that did not select the optimal group of patients for therapy. Histological diagnosis of the inflammatory process may have been inaccurate and the study did not take into consideration the spontaneous course of the disease or a possible viral persistence [2–8]. Though the prerequisites for diagnosing virus-induced myocardial disease have been considerably improved by new diagnostic techniques in recent years, there have not yet been any prospective randomized therapeutic studies with precisely characterized patient populations. Ultimately decisive for the development of adequate therapeutic strategies, however, is a precise clinical evaluation of the patients to be treated. Besides documenting the clinical status, it is extremely important to differentially analyze the inflammatory reaction and possible viral persistence in the myocardial tissue by histological, immunohistological and molecular-biological techniques . The histological and particularly the immunohistological techniques accurately detect both the acute and chronic myocardial inflammatory process [9,10]. New highly sensitive molecular-biological methods such as in situ hybridization and the polymerase chain reaction (PCR) now detect the viral genome (e.g., enteroviruses) even for latent infection with restricted replication [11–15]. Only these differential diagnostics enable precise characterization of the disease process, which is now a prerequisite for the appropriate selection of patients for treatment.
KeywordsDilate Cardiomyopathy Endomyocardial Biopsy Acute Myocarditis Myocardial Biopsy Cardiac Inflammation
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