..

.

Dallas :

60%,

80%

"an inflammatory infiltrate of the myocardium with necrosis and/or degeneration of adjacent myocytes

not

typical of the ischemic damage associated with coronary heart disease". The infiltrates are usually mononuclear, but may be neutrophilic

or, occasionally, eosinophilic

Borderline myocarditis: inflammatory infiltrate is too sparse, or myocyte

injury is not demonstrated

: 0.05% (Karjalainen

J, Acta

Med Scand 1983)

1975-1985:

coxsackievirus

B had the

highest incidence (34.6/1000 population), followed by influenza B (17.4 cases), influenza

A (11.7

cases), coxsackievirus

A (9.1 cases), and cytomegalovirus

(CMV) (8.0 cases)

Grist NR, Reid D. Epidemiology of viral infections of the heart

Mason, Trehan, Renlund, Myocarditis

in

Cardiovascular Disease, Willerson and Cohn, 2007

Bowles et al, J AmColl Cardiol

2003;42:466

Dennert, European Heart Journal (2008) 29, 2073

Andreoletti

Archives of Cardiovascular Disease (2009) 102, 559

Badorff

Nat Med 1999

(10%

)

Dennert, European Heart Journal (2008) 29, 2073

-

CPK, cTnI, cTnT

MRI

=124

:9%

:77%

:25%

:49%

Mahfoud

et al. Eur

Heart J 2011

. -

0102030405060708090

100

Pooled Histological

SensitivitySpecificityPPVNPV

MRI

Dallas criteria

anti-CD3, anti-CD4, anti-CD20, anti-CD28, and anti-

human leukocyte antigen

PCR

In situ

hybridization

;

;

lymphocytic, eosinophilic,polymorphous,giant cell, and granulomatous

myocarditis

a cut-off of >14 leucocytes/mm2

T lymphocytes > 7 cells/mm2

Kuhl et

al.1996 Maisch

et

al. 1998

Veinot, Cardiovascular Pathology

T-cell infiltration

DAmbrosio

et al, Heart 2001

Cooper L et al, Circulation 2007

-E

Cooper L et al, Circulation 2007

number of biopsy samples increases sensitivity

Chow et

al. (1989) and Hauck

et

al. (1989) sensitivity 50% using four to five biopsy

samples

When

17 biopsy specimens per case were

considered, the sensitivity reached

79% Chow et

al. 1989

Dennert, European Heart Journal (2008) 29, 2073

D

Ambrosio

et al, Heart 2001

The mortality rate for patients with myocarditis with heart failure is 20% at 1 year and 56% at 4 years

Mason et

al. 1995

McCarthy et al, New Engl

J Med 2000

Group 2: HF

Corrado

Cardiovasc

Res 2001

A 17-year-old, previously asymptomatic, boy who died suddenly at rest.

Basso C et al. Cardiovasc Res 2001;50:290-300

Kindermann et al, Circulation 2008;118;639

N=181

50%

40%

Kuhl et al. Circulation. 2005;112:1965

=172

-

-

(-ICD)

;

;

MTT trial

Mason J, N Engl J Med 1995;333:269

Cooper LT

et al, N Engl

J Med 1997

41

, 6

-

21

(

3-HCV)

20

(

17-

, -V)

Frustaci

et al, Circulation. 2003;107:857

Virus negative inflammatory cardiomyopathy

;

Frustaci

et al, European Heart Journal (2009) 30, 1995

=85>6

Kuhl U,

Circulation 2003: 107:2793

1.

=22

2.

44

3.

-

-

-

,

Slide Number 5Slide Number 6Slide Number 7 - Slide Number 13Slide Number 14 MRIDallas criteria Slide Number 18Slide Number 19Slide Number 20T-cell infiltration -ESlide Number 23Slide Number 24Slide Number 25 Slide Number 27Slide Number 28 Slide Number 30 Slide Number 32 Slide Number 34 MTT trialSlide Number 38 Virus negative inflammatory cardiomyopathy; - Slide Number 43Slide Number 44