Schultheiss Heinz-Peter, Baumeier Christian, Aleshcheva Ganna, Bock C-Thomas, Escher Felicitas
Institute of Cardiac Diagnostics and Therapy, IKDT GmbH, 12203 Berlin, Germany.
Division of Viral Gastroenteritis and Hepatitis Pathogens and Enteroviruses, Department of Infectious Diseases, Robert Koch Institute, 13353 Berlin, Germany.
J Clin Med. 2021 Nov 11;10(22):5240. doi: 10.3390/jcm10225240.
The diagnosis of acute and chronic myocarditis remains a challenge for clinicians. Characterization of this disease has been hampered by its diverse etiologies and heterogeneous clinical presentations. Most cases of myocarditis are caused by infectious agents. Despite successful research in the last few years, the pathophysiology of viral myocarditis and its sequelae leading to severe heart failure with a poor prognosis is not fully understood and represents a significant public health issue globally. Most likely, at a certain point, besides viral persistence, several etiological types merge into a common pathogenic autoimmune process leading to chronic inflammation and tissue remodeling, ultimately resulting in the clinical phenotype of dilated cardiomyopathy. Understanding the underlying molecular mechanisms is necessary to assess the prognosis of patients and is fundamental to appropriate specific and personalized therapeutic strategies. To reach this clinical prerequisite, there is the need for advanced diagnostic tools, including an endomyocardial biopsy and guidelines to optimize the management of this disease. The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has currently led to the worst pandemic in a century and has awakened a special sensitivity throughout the world to viral infections. This work aims to summarize the pathophysiology of viral myocarditis, advanced diagnostic methods and the current state of treatment options.
急性和慢性心肌炎的诊断对临床医生来说仍然是一项挑战。这种疾病的特征因病因多样和临床表现异质性而受到阻碍。大多数心肌炎病例由感染因子引起。尽管在过去几年里研究取得了成功，但病毒性心肌炎的病理生理学及其导致严重心力衰竭且预后不良的后遗症仍未完全了解，这在全球范围内是一个重大的公共卫生问题。很可能在某个阶段，除了病毒持续存在外，几种病因类型会合并为一个共同的致病性自身免疫过程，导致慢性炎症和组织重塑，最终导致扩张型心肌病的临床表型。了解潜在的分子机制对于评估患者预后至关重要，也是制定适当的特异性和个性化治疗策略的基础。为满足这一临床前提条件，需要先进的诊断工具，包括心内膜心肌活检以及优化该疾病管理的指南。严重急性呼吸综合征冠状病毒2（SARS-CoV-2）目前已引发了一个世纪以来最严重的大流行，并在全球范围内唤起了人们对病毒感染的特殊敏感性。这项工作旨在总结病毒性心肌炎的病理生理学、先进的诊断方法以及当前治疗选择的现状。
