Maisch B, Alter P
Fachbereich Medizin, Philipps-Universität Marburg und Herz- und Gefäßzentrum (HGZ) Marburg, Feldbergstr. 45, 35043, Marburg, Germany.
Klinik für Innere Medizin-Pneumologie und Intensivmedizin, UKGM und Philipps-Universität Marburg, Marburg, Germany.
Herz. 2018 Aug;43(5):423-430. doi: 10.1007/s00059-018-4719-x.
For myocarditis and inflammatory cardiomyopathy, an etiologically driven treatment is today the best option beyond heart failure therapy. Prerequisites for this are noninvasive and invasive biomarkers including endomyocardial biopsy and polymerase chain reaction on cardiotropic agents. Imaging by Doppler echocardiography and cardiac magnetic resonance imaging as well as cardiac biomarkers such as C‑reactive protein, N‑terminal pro-B-type natriuretic peptide , and troponins can contribute to the clinical work-up of the syndrome but not toward elucidating the underlying cause or pathogenetic process. This review summarizes the phases and clinical features of myocarditis and gives an up-to-date short overview of the current treatment options starting with heart failure and antiarrhythmic therapy. Although inflammation in myocardial disease can resolve spontaneously, often specific treatment directed against the causative agent is required. For fulminant, acute, and chronic autoreactive myocarditis, immunosuppressive treatment has proven to be beneficial in the TIMIC and ESETCID trials; for viral cardiomyopathy and myocarditis, intravenous immunoglobulin IgG subtype and polyvalent intravenous immunoglobulins IgG, IgA, and IgM can frequently resolve inflammation. However, despite the elimination of inflammation, the eradication of parvovirus B19 and human herpesvirus-6 is still a challenge, for which ivIg treatment can become a future key player.
对于心肌炎和炎症性心肌病,除心力衰竭治疗外,病因驱动的治疗是目前的最佳选择。其前提条件是包括心内膜心肌活检和针对嗜心肌病原体的聚合酶链反应在内的非侵入性和侵入性生物标志物。多普勒超声心动图和心脏磁共振成像等影像学检查以及C反应蛋白、N末端B型利钠肽原和肌钙蛋白等心脏生物标志物有助于该综合征的临床检查,但无助于阐明潜在病因或发病机制。本综述总结了心肌炎的阶段和临床特征,并对从心力衰竭和抗心律失常治疗开始的当前治疗选择进行了最新的简要概述。虽然心肌疾病中的炎症可自发消退,但通常需要针对病原体的特异性治疗。对于暴发性、急性和慢性自身反应性心肌炎,免疫抑制治疗在TIMIC和ESETCID试验中已被证明是有益的;对于病毒性心肌病和心肌炎,静脉注射免疫球蛋白IgG亚型以及多价静脉注射免疫球蛋白IgG、IgA和IgM通常可消除炎症。然而,尽管炎症得以消除,但根除细小病毒B19和人类疱疹病毒6仍然是一项挑战,静脉注射免疫球蛋白治疗可能会成为未来应对这一挑战的关键手段。
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