Myocarditis is an inflammatory disease of the myocardium caused by infectious or non-infectious a... more Myocarditis is an inflammatory disease of the myocardium caused by infectious or non-infectious agents. It can lead to serious short-term and long-term sequalae, such as sudden cardiac death or dilated cardiomyopathy. Due to its heterogenous clinical presentation and disease course, challenging diagnosis and limited evidence for prognostic stratification, myocarditis poses a great challenge to clinicians. As it stands, the pathogenesis and etiology of myocarditis is only partially understood. Moreover, the impact of certain clinical features on risk assessment, patient outcomes and treatment options is not entirely clear. Such data, however, are essential in order to personalize patient care and implement novel therapeutic strategies. In this review, we discuss the possible etiologies of myocarditis, outline the key processes governing its pathogenesis and summarize best available evidence regarding patient outcomes and state-of-the-art therapeutic approaches.
We determined retrospective analysis of the diagnostic value of virus serology in patients with n... more We determined retrospective analysis of the diagnostic value of virus serology in patients with non-ischemic systolic heart failure and parvovirus B19 infection. Virus serology and endomyocardial biopsy were performed in 31 patients with non-ischemic systolic heart failure hospitalized from 2001 to 2006 in our clinic. The serum specimens from 31 patients were tested for IgM and IgG antibody against parvovirus B19. IgM antibodies were identified in 3 patients and IgG antibodies were identified in 23 patients. All of the patients underwent endomyocardial biopsy which revealed chronic active myocarditis in 10 patients (32.4%), chronic persistent myocarditis in 14 patients (45.1%) and no myocarditis in 7 patients (22.5%). Virus serology has no relevance for the diagnosis of non-ischemic systolic heart failure caused by parvovirus B19 infection. The result of serological tests are positive more frequently than the biopsy specimens results.
Background. As shown recently, macrophages have proved most suitable for the chronic stage of myo... more Background. As shown recently, macrophages have proved most suitable for the chronic stage of myocarditis (MCI). The study aim. Accordingly, the aim of this study was to determine the number of CD68(+) macrophages adhered to injured cardiac myocytes in biopsy of patients with dilated cardiomyopathy (DCM) and clinical suspicion of MCI. Patients and Methods. The study group consisted of 181 patients with DCM (159M, 22F, mean duration of symptoms was 1.8 years) and decreased left ventricular ejection fraction (< 40%). Immunohistochemistry on cryostat sections was performed using a Leica Bond Max autostainer and murine monoclonal antihuman antibodies anti-CD68(+) macrophages (cloneEBM11) from DAKO, Denmark. The total number of CD68(+) macrophages and the number of CD68 macrophages attached to injured cardiomyocytes were counted in at least 10 high power fields under 400x magnification and converted into the number of cells/mm2. Results. Two expression patterns of CD68(+) macrophages ...
This study aimed to define relationship between PPARαexpression and metabolic-structural characte... more This study aimed to define relationship between PPARαexpression and metabolic-structural characteristics during HF progression in hearts with DCM phenotype. Tissue endomyocardial biopsy samples divided into three groups according to LVEF ((I) 45–50%,n=10; (II) 30–40%,n=15; (III) <30%,n=15; and control (donor hearts, >60%,n=6)) were investigated. The PPARαmRNA expression in the failing hearts was low in Group (I), high in Group (II), and comparable to that of the control in Group (III). There were analogous changes in the expression of FAT/CD36 and CPT-1 mRNA in contrast to continuous overexpression of GLUT-4 mRNA and significant increase of PDK-4 mRNA in Group (II). In addition, significant structural changes of cardiomyocytes with glycogen accumulation were accompanied by increased expression of PPARα. For the entire study population with HF levels of FAT/CD36 mRNA showed a strong tendency of negative correlation with LVEF. In conclusion, PPARαelevated levels may be a direct ...
Myocarditis is an inflammatory disease of the myocardium caused by infectious or non-infectious a... more Myocarditis is an inflammatory disease of the myocardium caused by infectious or non-infectious agents. It can lead to serious short-term and long-term sequalae, such as sudden cardiac death or dilated cardiomyopathy. Due to its heterogenous clinical presentation and disease course, challenging diagnosis and limited evidence for prognostic stratification, myocarditis poses a great challenge to clinicians. As it stands, the pathogenesis and etiology of myocarditis is only partially understood. Moreover, the impact of certain clinical features on risk assessment, patient outcomes and treatment options is not entirely clear. Such data, however, are essential in order to personalize patient care and implement novel therapeutic strategies. In this review, we discuss the possible etiologies of myocarditis, outline the key processes governing its pathogenesis and summarize best available evidence regarding patient outcomes and state-of-the-art therapeutic approaches.
We determined retrospective analysis of the diagnostic value of virus serology in patients with n... more We determined retrospective analysis of the diagnostic value of virus serology in patients with non-ischemic systolic heart failure and parvovirus B19 infection. Virus serology and endomyocardial biopsy were performed in 31 patients with non-ischemic systolic heart failure hospitalized from 2001 to 2006 in our clinic. The serum specimens from 31 patients were tested for IgM and IgG antibody against parvovirus B19. IgM antibodies were identified in 3 patients and IgG antibodies were identified in 23 patients. All of the patients underwent endomyocardial biopsy which revealed chronic active myocarditis in 10 patients (32.4%), chronic persistent myocarditis in 14 patients (45.1%) and no myocarditis in 7 patients (22.5%). Virus serology has no relevance for the diagnosis of non-ischemic systolic heart failure caused by parvovirus B19 infection. The result of serological tests are positive more frequently than the biopsy specimens results.
Background. As shown recently, macrophages have proved most suitable for the chronic stage of myo... more Background. As shown recently, macrophages have proved most suitable for the chronic stage of myocarditis (MCI). The study aim. Accordingly, the aim of this study was to determine the number of CD68(+) macrophages adhered to injured cardiac myocytes in biopsy of patients with dilated cardiomyopathy (DCM) and clinical suspicion of MCI. Patients and Methods. The study group consisted of 181 patients with DCM (159M, 22F, mean duration of symptoms was 1.8 years) and decreased left ventricular ejection fraction (< 40%). Immunohistochemistry on cryostat sections was performed using a Leica Bond Max autostainer and murine monoclonal antihuman antibodies anti-CD68(+) macrophages (cloneEBM11) from DAKO, Denmark. The total number of CD68(+) macrophages and the number of CD68 macrophages attached to injured cardiomyocytes were counted in at least 10 high power fields under 400x magnification and converted into the number of cells/mm2. Results. Two expression patterns of CD68(+) macrophages ...
This study aimed to define relationship between PPARαexpression and metabolic-structural characte... more This study aimed to define relationship between PPARαexpression and metabolic-structural characteristics during HF progression in hearts with DCM phenotype. Tissue endomyocardial biopsy samples divided into three groups according to LVEF ((I) 45–50%,n=10; (II) 30–40%,n=15; (III) <30%,n=15; and control (donor hearts, >60%,n=6)) were investigated. The PPARαmRNA expression in the failing hearts was low in Group (I), high in Group (II), and comparable to that of the control in Group (III). There were analogous changes in the expression of FAT/CD36 and CPT-1 mRNA in contrast to continuous overexpression of GLUT-4 mRNA and significant increase of PDK-4 mRNA in Group (II). In addition, significant structural changes of cardiomyocytes with glycogen accumulation were accompanied by increased expression of PPARα. For the entire study population with HF levels of FAT/CD36 mRNA showed a strong tendency of negative correlation with LVEF. In conclusion, PPARαelevated levels may be a direct ...
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Papers by Romuald Wojnicz