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Myokarditis

Myocarditis

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Zusammenfassung

Die Myokarditis gilt zunehmend als eine relativ häufige, unterschiedlich ausgeprägte Erkrankung des Herzmuskels, wenngleich symptomarm und daher eher selten klinisch diagnostiert. Die Diagnostik von Myokarditiden hat mit der Einführung immunhistochemischer und molekularpathologischer Methoden eine erhebliche Verbesserung erfahren. Die bisherige konventionell-histologische Diagnostik nach den sog. Dallas-Kriterien konnte Unsicherheiten nicht beheben. Die immunhistochemische Charakterisierung und Quantifizierung von Entzündungszellen im myokardialen Interstitium und die Darstellung der Expression auch nichtzellulärer proinflammatorischer Moleküle kann mit größerer diagnostischer Zuverlässigkeit zu der Diagnose einer akuten oder chronischen Myokarditis führen, insbesondere konnten virale Myokarditiden als Ursache einer dilatativen Kardiomyopathie identifiziert werden. Bestätigt wird die Aussagekraft immunhistochemischer Untersuchungen durch den verbesserten Nachweis auslösender Erreger, insbesondere Viren, mithilfe molekularpathologischer Methoden. Vor allem potenziell maligne Arrhythmieformen infolge einer Myokarditis sind bei der Differenzialdiagnose des plötzlichen Todes zu berücksichtigen.

Abstract

Myocarditis is a common cardiac disease but diagnosis can be difficult according to the Dallas criteria which have been criticised as being too unreliable. The diagnosis has been improved due to immunohistochemical techniques for characterisation and quantification of myocardial inflammatory reactions as well as molecular pathological methods for viral genome detection. These new immunohistochemical and molecular pathological methods have confirmed the persistence of viral infection and chronic myocardial inflammation in a considerable number of patients. A causal link between viral myocarditis and the development of dilated cardiomyopathy or inflammatory cardiomyopathy has been recognised. Potentially malignant tachyarrhythmias and bradyarrhythmias are of particular significance in the differential diagnosis of sudden cardiac death due to myocarditis.

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Literatur

  1. Abelmann WH (1966) Myocarditis. N Engl J Med 275: 944–945

    PubMed  Google Scholar 

  2. Aretz HT (1987) Myocarditis: the Dallas Criteria. Hum Pathol 18: 619–624

    PubMed  Google Scholar 

  3. Aretz HT, Billingham ME, Edwards W et al. (1987) Myocarditis: a histopathologic definition and classification. Am J Cardiovasc Pathol 1: 5–14

    Google Scholar 

  4. Bergelson JM, Cunningham JA, Droguett G et al. (1997) Isolation of a common receptor for coxsackie B viruses and adenoviruses 2 and 5. Science 275: 1320–1323

    Article  PubMed  Google Scholar 

  5. Bowles NE (1986) Detection of coxsackie-B-virus-specific RNA sequences in myocardial biopsy samples from patients with myocarditis and dilated cardiomyopathy. Lancet 1: 1120–1122

    Article  PubMed  Google Scholar 

  6. Braun R, Hassler D, Kimmig P (2002) Myokarditis durch Enteroviren in Griechenland – Und bei uns? Dtsch Med Wochenschr 127: 1364

    PubMed  Google Scholar 

  7. Brodison A, Swann JW (1998) Myocarditis: a review. J Infect 37: 99–103

    Article  PubMed  Google Scholar 

  8. Dec GW, Fallon JT, Southern JF (1990) Borderline myocarditis and the indication for repeat endomyocardial biopsy. J Am Coll Cardiol 15: 283–289

    PubMed  Google Scholar 

  9. Dettmeyer R, Madea B (2004) Sudden, unexpected death related to viral myocarditis. A survey of histological, immunohistochemical and molecular pathological methods for the postmortem diagnosis. In: Tsokos M (Hrsg) Forensic pathology reviews, vol 2. Humana Press, Tatowa NJ, pp 169–186

  10. Dettmeyer R, Reith K, Madea B (2002) Alcoholic cardiomyopathy versus chronic myocarditis – Immunhistological investigations with LCA, CD3, CD68 and tenascin. Forensic Sci Int 126: 57–62

    Article  PubMed  Google Scholar 

  11. Dettmeyer R, Baasner A, Schlamann M et al. (2002) Coxsackie B3 myocarditis in 4 cases of suspected sudden infant death syndrome. Pathol Res Pract 198: 689–696

    Article  PubMed  Google Scholar 

  12. Dettmeyer R, Baasner A, Schlamann M et al. (2004) Role of virus-induced myocardial affections in sudden infant death syndrome: a prospective postmortem study. Pediatr Res 55: 947–952

    Article  PubMed  Google Scholar 

  13. Edwards WD, Holmes DR, Reeder GS (1982) Diagnosis of active lymphocytic myocarditis by endomyocardial biopsy. Quantitative criteria for light microscopy. Mayo Clin Proc 57: 419–425

    PubMed  Google Scholar 

  14. Fairley CK, Ryan M, Wall PG, Weinberg J (1996) The organisms reported to cause infective myocarditis and pericarditis in England and Wales. J Infect 32: 223–225

    Article  PubMed  Google Scholar 

  15. Feldmann AM, McNamara D (2000) Myocarditis. New Engl J Med 343: 1388–1398

    Article  PubMed  Google Scholar 

  16. Fenoglio JJ, Ursell PC, Kellog CF et al. (1983) Diagnosis and classification of myocarditis by endomyocardial biopsy. New Engl J Med 308: 12–18

    PubMed  Google Scholar 

  17. Forcada P, Beigelmann J, Milei J (1996) Inapparent myocarditis and sudden death in pediatrics. Diagnosis by immunhistochemical staining. Int J Cardiol 56: 93–97

    Article  PubMed  Google Scholar 

  18. Foulis AK, Farquharson MA, Cameron SO et al. (1990) A search for the presence of the enteroviral capsid protein VP1 in pancreas of patients with type 1 (insulin-dependent) diabetes and pancreases and hearts of infants who died of coxsackieviral myocarditis. Diabetologia 33: 290–298

    Article  PubMed  Google Scholar 

  19. Friman G, Wesslem L, Fohlman J et al. (1995) The epidemiology of infectious myocarditis, lymphocytic myocarditis and dilated cardiomyopathy. Eur Heart J 16 [Suppl O]: 36–41

  20. Gravanis M, Sternby N (1991) Incidence of myocarditis. Arch Pathol Lab Med 115: 390–392

    PubMed  Google Scholar 

  21. Hauck AJ, Kearney DL, Edwards WD (1989) Evaluation of postmortem endomyocardial biopsy specimens from 38 patients with lymphocytic myocarditis: implications for role of sampling error. Mayo Clin Proc 64: 1235–1245

    PubMed  Google Scholar 

  22. Hayes MA, Russel RG, Babiuk LA (1979) Sudden death in young dogs with myocarditis caused by parvovirus. J Am Vet Med Assoc 174: 1197–1203

    PubMed  Google Scholar 

  23. Herskowitz A, Campbell S, Deckers J et al. (1993) Demographic features and prevalence of idiopathic myocarditis in patients undergoing endomyocardial biopsy. Am J Cardiol 71: 982–986

    Article  PubMed  Google Scholar 

  24. Higuchi de Lourdes M, Morais de CF, Sambiase NV et al. (1990) Histopathological criteria of myocarditis. A study based on normal heart, chagasic heart and dilated cardiomyopathy. Jpn Circ J 54: 391–400

    PubMed  Google Scholar 

  25. Holgate CS, Jackson P, Pollard K et al. (1986) Effect of fixation on T and B lymphocyte surface membrane antigen demonstration in paraffin processed tissue. J Pathol 149: 293–300

    Article  PubMed  Google Scholar 

  26. Hort W (Hrsg) (1999) Pathologie des Endokard, der Kranzarterien und des Myokard. Springer, Berlin Heidelberg New York Tokyo

  27. Jim O, Sole M, Butany JW et al. (1990) Detection of enterovirus RNA in myocardial biopsies from patients with myocarditis and cardiomyopathy using gene amplification by polymerase chain reaction. Circulation 82: 8–16

    PubMed  Google Scholar 

  28. Kandolf R (1995) Molekulare Pathogenese der Enterovirusmyokarditis. Viruspersistenz und chronische Entzündung. Internist 36: 430–438

    PubMed  Google Scholar 

  29. Kandolf R, Ameis D, Kirschner P et al. (1987) In situ detection of enteroviral genomes in myocardial cells by nucleic acid hybridization: an approach to the diagnosis of viral heart disease. Proc Natl Acad Sci USA 84(17): 6272–6276

    PubMed  Google Scholar 

  30. Kingel K, Rieger P, Selinka HC et al. (1994) Nachweis virusinduzierter zytopathogener Effekte bei der enteroviralen Myokarditis durch elektronenmikroskopische in situ Hybridisierung. Verh Dtsch Ges Pathol 78: 469

    Google Scholar 

  31. Klein RM, Vester EG, Perings C, Strauer BE (1995) Arrhythmien bei Myokarditis. Internist 36: 358–368

    Google Scholar 

  32. Klein RM, Vester EG, Brehm MU et al. (2000) Entzündung des Myokards als Arrhythmietrigger. Z Kardiol 89 [Suppl 3]: III/24–35

  33. Kühl U, Daun B, Seeberg B et al. (1992) Dilatative Kardiomyopathie – Eine chronische Myokarditis? Herz 17: 97–106

    PubMed  Google Scholar 

  34. Kühl U, Pauschinger M, Schultheiss HP (1997) Neue Konzepte zur Diagnostik der entzündlichen Herzmuskelerkrankung. Dtsch Med Wochenschr 122: 690–698

    PubMed  Google Scholar 

  35. Kwok S, Higuchi R (1989) Avoiding false positives with PCR. Nature 339: 237–238

    Article  PubMed  Google Scholar 

  36. Kytö V, Vuorinen T, Saukko P et al. (2005) Cytomegalovirus infection of the heart is common in patients with fatal myocarditis. Clin Infect Dis 40: 683–688

    Article  PubMed  Google Scholar 

  37. Lentini S, Klingel K, Skowasch R et al. (2001) Epstein-Barr Virus assoziierte Perikarditis. Dtsch Med Wochenschr 126: 1043–1046

    Article  PubMed  Google Scholar 

  38. Li Y, Bourlet T, Andreoletti L et al. (2000) Enteroviral capsid protein VP1 is present in myocardial tissues from some patients with myocarditis or dilated cardiomyopathy. Circulation 101: 231–234

    PubMed  Google Scholar 

  39. Linder J, Cassling RS, Rogler WC et al. (1985) Immunohistochemical characterization of lymphocytes in uninflamed ventricular myocardium. Arch Pathol Lab Med 109: 917–920

    PubMed  Google Scholar 

  40. Liu PP, Mason JW (2001) Advances in the understanding of myocarditis. Circulation 104: 1076–1082

    PubMed  Google Scholar 

  41. Lozinski GM, Davis GG, Krous HF et al. (1994) Adenovirus myocarditis: retrospective diagnosis by gene amplification from formalin-fixed, paraffin-embedded tissues. Hum Pathol 25: 831–834

    Article  PubMed  Google Scholar 

  42. Maisch B (1994) Myokarditis. Internist 35: 91–93

    PubMed  Google Scholar 

  43. Maisch B, Schönian U, Herzum M, Hufnagel G (1995) Immunserologische und immunhistologische Untersuchungen bei Myokarditis und Perikarditis. Internist 36: 448–457

    PubMed  Google Scholar 

  44. Mall G (1995) Morphologie der Myokarditis. Internist 36: 426–429

    PubMed  Google Scholar 

  45. Mileii J, Bortman G, Fernandez-Alonso G et al. (1990) Immunhistochemical staining of lymphocytes for the reliable diagnosis of myocarditis in endomyocardial biopsies. Cardiology 77: 77–85

    PubMed  Google Scholar 

  46. Miller R, Ward C, Amsterdam E (1973) Focal mononucleosis myocarditis simulating myocardial infarction. Chest 63: 102–105

    PubMed  Google Scholar 

  47. Mounts AW, Amr S, Jamshidi R et al. (2001) A cluster of fulminant myocarditis cases in children, Baltimore, Maryland, 1997. Pediatr Cardiol 22: 34–39

    Article  PubMed  Google Scholar 

  48. Muir P (1993) Enteroviruses and heart disease. Br J Biomed Sci 50: 258–271

    PubMed  Google Scholar 

  49. Noutsias M, Seeberg B, Schultheiss HP, Kühl U (1996) Immunhistological evidence for a chronic intramyocardial process in dilated cardiomyopathy. Heart 75: 295–300

    PubMed  Google Scholar 

  50. Noutsias M, Pauschinger M, Kühl U, Schultheiss HP (2002) Myokarditis und dilatative Kardiomyopathie. Neue Wege in Diagnostik und Therapie. Munch Med Wochenschr 144: 36–40

    Google Scholar 

  51. Ono K, Matsumori A, Shioi T et al. (1999) Contribution of endothelin-1 to myocardial injury in a murine model of myocarditis. Acute effects of bosentan, an endothelin receptor antagonist. Circulation 100: 1823–1829

    PubMed  Google Scholar 

  52. Pankuweit S, Portik I, Eckhardt H et al. (2000) Prevalence of viral genome in endomyocardial biopsies from patients with inflammatory heart muscle disease. Herz 25: 221–226

    Article  PubMed  Google Scholar 

  53. Passarino G, Burlo P, Ciccone G et al. (1997) Prevalence of myocarditis at autopsy in Turin, Italy. Arch Pathol Lab Med 121: 619–622

    PubMed  Google Scholar 

  54. Pauschinger M, Badorff C, Kühl U et al. (1998) Synkope bei AV-Block III-Nachweis von Virusgenom im Myokard. Dtsch Med Wochenschr 123: 1443–1446

    PubMed  Google Scholar 

  55. Pauschinger M, Kühl U, Dörner A et al. (1998) Nachweis enteroviraler RNA in endomyokardialen Biopsien bei inflammatorischer Kardiomyopathie und idiopathischer dilatativer Kardiomyopathie. Z Kardiol 87: 443–452

    Article  PubMed  Google Scholar 

  56. Pauschinger M, Noutsias M, Li J et al. (2002) Virusinfektion als Ursache von Kardiomyopathien – Differenzierte Diagnostik. Med Welt 53: 14–18

    Google Scholar 

  57. Phillips CA, Aronson MD, Tomkow J, Phillips ME (1980) Enteroviruses in Vermont, 1969–1978: an important cause of illness throughout the year. J Infect Dis 141: 162–164

    PubMed  Google Scholar 

  58. Rasten-Almquist P, Eksborg S, Rajs J (2002) Myocarditis and sudden infant death syndrome. APMIS 110: 469–480

    Article  PubMed  Google Scholar 

  59. Richardson P, McKenna W, Bristow M et al. (1996) Report on the 1995 World Health Organization/International Society and Federation of Cardiology Task Force on the Definition and Classification of Cardiomyopathies. Circulation 93: 841–842

    PubMed  Google Scholar 

  60. Rohayem J, Dinger J, Fischer R et al. (2001) Fatal myocarditis associated with acute parvovirus B19 and human herpesvirus 6 coinfection. J Clin Microbiol 39: 4585–4587

    Article  PubMed  Google Scholar 

  61. Schewe C, Rizzelo M, Dietel M, Hauptmann S (2000) Zur PCR-basierten Erregerdiagnostik in der Pathologie. Pathologe 21: 218–228

    Article  PubMed  Google Scholar 

  62. Schmaltz AA (2004) Inflammatorische Kardiomyopathie – Chronische Myokarditis. Monatsschr Kinderheilkd 152: 632–638

    Article  Google Scholar 

  63. Schnitt SJ, Ciano PS, Schoen FJ (1987) Quantification of lymphocytes in endomyocardial biopsies. Hum Pathol 18: 796–800

    PubMed  Google Scholar 

  64. Schultheiss HP (1993) Die dilatative Kardiomyopathie – Eine chronische Myokarditis? Neue Aspekte zur Diagnostik und Therapie. Z Kardiol 82 [Suppl 4]: 25–33

  65. Schultheiß HP, Pauschinger M, Kühl U (1998) Pathogenese der entzündlichen Kardiomyopathie. Med Klin 93: 229–235

    Google Scholar 

  66. Schwartzkopff B, Klein RM, Strauer BE (1995) Diagnostik und Therapie der Myokarditis. Internist 36: 469–483

    PubMed  Google Scholar 

  67. Schwimmbeck PL, Rohn G, Wrusch A et al. (2000) Enteroviral and immune mediated myocarditis in SCID mice. Herz 25: 240–244

    Article  PubMed  Google Scholar 

  68. Shanes JG, Ghali J, Billingham ME et al. (1987) Interobserver variability in the pathologic interpretation of endomyocardial biopsy results. Circulation 75: 401–405

    PubMed  Google Scholar 

  69. Sigrist T, Germann U (1998) Morphologische Veränderungen am Erregungsleitungssystem für die Diagnose des „akuten Herztodes“ (zugleich eine Präparationsanleitung). Rechtsmedizin 8: 69–72

    Article  Google Scholar 

  70. Strauer B, Kandolf R, Mall G et al. (2001) Myokarditis – Kardiomyopathie. Update. Med Klin 96: 608–625

    Google Scholar 

  71. Wagner G, Gardiol D (1989) La myocardite dans un collectif d’autopsies. Schweiz Med Wochenschr 119: 641–646

    PubMed  Google Scholar 

  72. Woodruff JF (1980) Viral myocarditis. Am J Pathol 102: 424–449

    Google Scholar 

  73. Zell R, Klingel K, Bültmann B, Kandolf R (1995) Nachweis enteroviraler RNA aus Formalin-fixierten Paraffin-eingebetteten Myokardgewebe durch Nested RT-PCR. Verh Dtsch Ges Pathol 79: 359

    Google Scholar 

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  1. Institut für Rechtsmedizin, Rheinische Friedrich-Wilhelms-Universität, Stiftsplatz 12, 53111, Bonn

    R. Dettmeyer, M. Strehler, S. Winkelmann & B. Madea

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  1. R. Dettmeyer
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  2. M. Strehler
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  3. S. Winkelmann
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Correspondence to R. Dettmeyer.

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Dettmeyer, R., Strehler, M., Winkelmann, S. et al. Myokarditis. Rechtsmedizin 16, 138–142 (2006). https://doi.org/10.1007/s00194-006-0378-y

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