Update on Myocarditis
Update on Myocarditis
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DOI：
10.1016/j.jacc.2011.09.074
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发表时间：
2012-02-28
影响因子：
24
通讯作者：
Boehm, Michael
中科院分区：
文献类型：
--
作者：
Kindermann, Ingrid;Barth, Christine;Boehm, Michael
心肌炎是一种心脏炎症性疾病，常由病毒感染和/或病毒感染后的免疫介导反应引起。它是全球扩张型心肌病的重要病因之一。诊断依据临床表现以及心血管磁共振成像等非侵入性诊断方法推测。心肌内膜活检仍然是心肌炎体内诊断的金标准。最近在一些临床试验中已经证实了心肌内膜活检结果在治疗和预后方面的益处。尽管在过去几年中，在急性心肌炎的诊断、病理生理机制的理解以及治疗方面取得了显著进展，但除了标准的心力衰竭治疗和身体休息外，目前还无法确定标准的治疗策略。在严重病例中，可能需要机械辅助或心脏移植。有一些证据表明，免疫抑制和免疫调节治疗对慢性、病毒阴性的炎症性心肌病有效。需要通过对照、随机研究进一步调查，以明确确定它们在心肌炎治疗中的作用。（《美国心脏病学会杂志》2012年；59卷：779 - 792页）（美国心脏病学会基金会2012年版权所有）
Myocarditis is an inflammatory disease of the heart frequently resulting from viral infections and/or post-viral immune-mediated responses. It is one of the important causes of dilated cardiomyopathy worldwide. The diagnosis is presumed on clinical presentation and noninvasive diagnostic methods such as cardiovascular magnetic resonance imaging. Endomyocardial biopsy remains the gold standard for in vivo diagnosis of myocarditis. The therapeutic and prognostic benefits of endomyocardial biopsy results have recently been demonstrated in several clinical trials. Although remarkable advances in diagnosis, understanding of pathophysiological mechanisms, and treatment of acute myocarditis were gained during the last years, no standard treatment strategies could be defined as yet, apart from standard heart failure therapy and physical rest. In severe cases, mechanical support or heart transplantation may become necessary. There is some evidence that immunosuppressive and immunomodulating therapy are effective for chronic, virus-negative inflammatory cardiomyopathy. Further investigations by controlled, randomized studies are needed to definitively determine their role in the treatment of myocarditis. (J Am Coll Cardiol 2012; 59: 779-92) (C) 2012 by the American College of Cardiology Foundation