Dilated cardiomyopathy: Pathogenesis and the recognition of early disease
In coxsackie B-, influenza and mumps-induced perimyocarditis the characteristic immunological features were cross-reacting cytolytic antimyolemmal antibodies, circulating immune complexes and no NK- or K-cell activity. Cytolytic antimyolemmal antibodies are markers of a secondary immunopathogenesis in perimyocarditis. In cytomegalovirus myocarditis antiinterfibrillary antibodies could be found and immune complexes were rarely observed. Postmyocarditic cardiomyopathy could be identified by circulating antimyolemmal and antisarcolemmal antibodies which also bind to the endomyocardial autopsy specimens. In these patients circulating immune complexes are more frequent than in normals and in dilated cardiomyopathy. In dilated cardiomyopathy antifibrillary and antiinterfibrillary antibodies were observed, the incidence of which correlated with the severity (NYHA) of the disease. A group of patients with dilated cardiomyopathy could be distinguished who demonstrated regardless of the severity lymphocytotoxic reactions against vital cardiocytes.