Viral myocarditis: from experimental models to molecular diagnosis in patients

  title={Viral myocarditis: from experimental models to molecular diagnosis in patients},
  author={Sabine Pankuweit and Karin Klingel},
  journal={Heart Failure Reviews},
Cardiotropic viruses have been implicated as major pathogenetic agents in acute and chronic forms of myocarditis. By the introduction of molecular tools, such as (RT-) polymerase chain reaction ((RT-) PCR) and in situ hybridization in the diagnosis of inflammatory heart disease, genomes of various RNA and DNA viruses comprising enteroviruses, adenoviruses, parvovirus B19 (B19V) and herpesviruses (EBV, HHV6, HCMV) were detected in endomyocardial biopsies of patients with myocarditis and dilated… 

Viral Myocarditis: From Experimental Models to Diagnosis in Patients

By investigation of immunocompetent and gene-targeted mice valuable new insights into host and virus factors relevant for the control of cardiac viral infection and inflammation were gained which are reviewed in this paper.

Persistent viral infections and their role in heart disease

The role of viral persistence in cardiac inflammation and heart disease is examined, its implications for patients’ outcomes are discussed, and it is suggested that certain viruses may persist in cardiac tissue after the initial infection.

Myocarditis in Humans and in Experimental Animal Models

This review describes the most commonly used mouse models of experimental myocarditis with a focus on the role of the innate and adaptive immune systems in induction and progression of the disease.

Autoimmunity in viral myocarditis

Antigenic mimicry between microbes and cardiac proteins causes autoimmunity in myocarditis, and characteristics of innate immunity associated with cardiac infection determine relevant epitope expression (cryptic epitopes).

The Spontaneous Course of Human Herpesvirus 6 DNA-Associated Myocarditis and the Effect of Immunosuppressive Intervention

In patients with lymphocytic myocarditis with low levels of HHV6 DNA, the spontaneous clinical improvement is nearby 60%, and steroid-based therapy was found to be effective and safe.

Viral presence guided immunomodulation in lymphocytic myocarditis: An update

This review systematically discusses the unsolved issues of immunomodulation guided by viral presence in acute lymphocytic myocarditis, namely virus epidemiology and prognosis, variability of viral presence rates, the role of potential viral bystander findings, and the main results of immunosuppression controlled trials in lymphocytes.

The spectrum of myocarditis: from pathology to the clinics

The elements supporting an aetiology-driven diagnostic work-up in myocarditis are reviewed, emphasizing the importance of integrating pathologic studies with clinical features and information derived from multimodality imaging and the potential of transcriptomic and proteomic analysis.

First therapeutic use of Artesunate in treatment of human herpesvirus 6B myocarditis in a child.




Pathophysiology and aetiological diagnosis of inflammatory myocardial diseases with a special focus on parvovirus B19.

The underlying dominant pathophysiological mechanisms in a large cohort of 3345 consecutive patients with left ventricular dysfunction evaluated over a period of 10 years were revealed, including parvovirus B19 genome, which was significantly correlated with inflammatory heart disease and reduced ejection fraction.

Association of parvovirus B19 genome in children with myocarditis and cardiac allograft rejection: diagnosis using the polymerase chain reaction.

Parvovirus genome identified through PCR analysis of cardiac tissue in the clinical setting of myocarditis and cardiac allograft rejection may be a potential contributor to cardiac transplant rejection.

Virus serology in patients with suspected myocarditis: utility or futility?

For patients with suspected myocarditis, virus serology has no relevance for the diagnosis of myocardial infection and endomyocardial biopsy remains the gold standard in the diagnostic of viralMyocarditis.

Viral Persistence in the Myocardium Is Associated With Progressive Cardiac Dysfunction

In this first biopsy-based analysis of the course of viral heart disease, it is shown that EV, ADV, PVB19, and HHV6 persistence detected in the myocardium of patients with LV dysfunction was associated with a progressive impairment of LVEF, whereas spontaneous viral elimination wasassociated with a significant improvement in LV function.

Cytomegalovirus infection of the heart is common in patients with fatal myocarditis.

In this population-based study, cytomegalovirus was found to be the most common specific finding in immunocompetent patients with fatal myocarditis and may have important clinical implications for the treatment of severe acuteMyocarditis.

Molecular pathogenesis of enterovirus-induced myocarditis: virus persistence and chronic inflammation.

There are therapeutic implications from the in situ demonstration of myocardial enterovirus infection, and Evaluation of specific antiviral agents, for example interferons, may lead to the development of new therapeutic strategies capable of providing protection against myocardials infection.

Viral Myocarditis: From the Perspective of the Virus

A clinical paradigm that focuses on the phases of viral infection and the molecular insights that are important for these phases of the infectious process with a focus on interactions between the virus and the cardiac myocyte is proposed.

Acute Myocarditis Rapid Diagnosis by PCR in Children

PCR offers a rapid, sensitive diagnostic method for myocardial viral infection while enterovirus is an important etiological agent, adenovirus was more prevalent in this series and should be evaluated when etiology is sought.

Characterisation of murine cytomegalovirus myocarditis: cellular infiltration of the heart and virus persistence.

The findings suggest that maintenance of the chronic phase of myocarditis involving post-viral immunological responses can occur in the presence of little infectious virus replication in the heart, suggesting latent viral infection of the heart.

From myocarditis to cardiomyopathy: mechanisms of inflammation and cell death: learning from the past for the future.

  • C. Kawai
  • Biology, Medicine
  • 1999
The rather discouraging results obtained to date with immunosuppressive agents in the treatment of viral myocarditis indicated the importance of sparing neutralizing antibody production, which may be controlled by B cells, and raised the possibility of promising developments in immunomodulating therapy.