Abstract

Review Article

Cardiomyopathies - The special entity of myocarditis and inflammatory cardiomyopathy

Felicitas Escher*, Uwe Kühl, Dirk Lassner and Heinz-Peter Schultheiss

Published: 01 July, 2019 | Volume 4 - Issue 2 | Pages: 053-070

Cardiomyopathy is a heart muscle disease with structural and functional myocardial abnormalities in the absence of coronary artery disease, hypertension, valvular disease, and congenital heart disease. However, it has become clear that diverse etiologies and clinical manifestations (e.g. arrhythmogenic right-ventricular cardiomyopathy/dysplasia (ARVC/D), ARVD/C, left-ventricular non-compaction cardiomyopathy (LVNC)) are responsible for the clinical picture of dilated cardiomyopathy (DCM).

The American Heart Association (AHA) classification grouped cardiomyopathies into genetic, mixed and acquired forms, while the European Society of Cardiology (ESC) classification proposed the subgrouping of each major type of cardiomyopathy into familial or genetic, and nonfamilial or nongenetic, forms [1-4].

Cardiomyopathies are clinically heterogeneous diseases, and there are differences in sex, age of onset, rate of progression, risk of development of overt heart failure and likelihood of sudden death within each cardiomyopathy subtype [5].

Because of the complex etiology and clinical presentation, the diagnostic spectrum in cardiomyopathies spans the entire range of non-invasive and invasive cardiological examination techniques including genetic analysis. The exact verification of certain cardiomyopathies necessitates additional investigations. So, histological, immunohistological and molecular biological/virological investigations of endomyocardial biopsies are the gold standard to confirm the diagnosis of an inflammatory cardiomyopathy (DCMi) [6-10].

This review focuses on myocarditis and inflammatory cardiomyopathies underlying an immune-mediated process or persistent viral infection.

Read Full Article HTML DOI: 10.29328/journal.jccm.1001041 Cite this Article Read Full Article PDF

References

  1. Maron BJ, Towbin JA, Thiene G, Antzelevitch C, Corrado D, et al.Contemporary definitions and classification of the cardiomyopathies: an American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention. Circulation. 2006; 113: 1807–1816. Ref.: http://bit.ly/2LuKdbV
  2. Elliott P, Andersson B, Arbustini E, Bilinska Z, Cecchi F, et al. Classification of the cardiomyopathies: a position statement from the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2008; 29: 270–276. Ref.: http://bit.ly/2LuE1AC
  3. Braunwald E. Cardiomyopathies: An Overview. Circ Res. 2017; 121: 711-721. Ref.: http://bit.ly/2ZXH8VJ
  4. McKenna WJ, Maron BJ, Thiene G. Classification, Epidemiology, and Global Burden of Cardiomyopathies. Circ Res. 2017; 121: 722-730. Ref.: http://bit.ly/3210w65
  5. Rose NR, Cihakova D. Cardiomyopathies. Autoimmunity. 2004; 37: 347-350.
  6. Caforio AL, Pankuweit S, Arbustini E, Basso C, Gimeno-Blanes J, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2013; 34: 2636-2648. Ref.: http://bit.ly/2xmI1uJ
  7. Schultheiss HP, Kuehl U, Cooper LT. The Management of Myocarditis. Eur Heart J. 2011; 32: 2616–2665. Ref.: http://bit.ly/2XJir1G
  8. Sagar S, Liu PP, Cooper LT. Myocarditis. Lancet. 2013; 379: 738–747. Ref.: http://bit.ly/2WTHXNx
  9. Calabrese F, Thiene G. Myocarditis and inflammatory cardiomyopathy: microbiological and molecular biological aspects. Cardiovasc Res. 2003; 60: 11-25. Ref.: http://bit.ly/2XfjgQy
  10. Pollack A, Kontorovich AR, Fuster V, Dec GW. Viral myocarditis--diagnosis, treatment options, and current controversies. Nat Rev Cardiol. 2015; 12: 670-680. Ref.: http://bit.ly/323VPZ5
  11. Bracamonte-Baran W, Čiháková D. Cardiac Autoimmunity: Myocarditis. Adv Exp Med Biol. 2017; 1003: 187-221. Ref.: http://bit.ly/2RMeJ1U
  12. Schultheiss HP, Fairweather D, Caforio ALP, Escher F, Hershberger RE, et al. Dilated cardiomyopathy. Nat Rev Dis Primers. 2019; 5: 32. Ref.: http://bit.ly/2XktA9O
  13. Rapezzi C, Arbustini E, Caforio AL, Charron P, Gimeno-Blanes J, et al. Diagnostic work-up in cardiomyopathies: bridging the gap between clinical phenotypes and final diagnosis. A position statement from the ESC Working Group on Myocardial and Pericardial Diseases. Eur Heart J. 2013; 34: 1448-1458. Ref.: http://bit.ly/2Yol0nd
  14. Agrawal N, Khunger A, Vachhani P, Colvin TA, Hattoum A, et al. Cardiac Toxicity Associated with Immune Checkpoint Inhibitors: Case Series and Review of the Literature. Case Rep Oncol. 2019 21; 12: 260-276. Ref.: http://bit.ly/2J0b8L6
  15. Merlo M, Cannatà A, Gobbo M, Stolfo D, Elliott PM, et al. Evolving concepts in dilated cardiomyopathy. Eur J Heart Fail. 2018; 20: 228-239. Ref.: http://bit.ly/2JgyScQ
  16. Weintraub RG, Semsarian C, Macdonald P. Dilated cardiomyopathy. Lancet. 2017; 390: 400-414. Ref.: http://bit.ly/2XlLZTN
  17. Trachtenberg BH, Hare JM. Inflammatory Cardiomyopathic Syndromes. Circ Res. 2017; 121: 803-818. Ref.: http://bit.ly/2FLdsU9
  18. Caforio AL, Marcolongo R, Basso C, Iliceto S. Clinical presentation and diagnosis of myocarditis. Heart. 2015; 101: 1332-1344. Ref.: http://bit.ly/2LvK8Vd
  19. Liu PP, Schultheiss HP. Myocarditis. In: Braunwald ed, Heart Disease. 8 ed. Philadelphia: W B Saunders co; 2008; 1775-1792.
  20. Heymans S, Eriksson U, Lehtonen J, Cooper LT Jr. The Quest for New Approaches in Myocarditis and Inflammatory Cardiomyopathy. J Am Coll Cardiol. 2016; 68: 2348-2364. Ref.: http://bit.ly/2J0QF8S
  21. Escher F, Kasner M, Kühl U, Heymer J, Wilkenshoff U, et al. New echocardiographic findings correlate with intramyocardial inflammation in endomyocardial biopsies of patients with acute myocarditis and inflammatory cardiomyopathy. Mediators Inflamm. 2013; 2013: 875420. Ref.: http://bit.ly/2NpKyPR
  22. Lurz P, Luecke C, Eitel I, Föhrenbach F, Frank C, et al. Comprehensive Cardiac Magnetic Resonance Imaging in Patients With Suspected Myocarditis: The MyoRacer-Trial. J Am Coll Cardiol. 2016; 19; 67: 1800-1811. Ref.: http://bit.ly/2ZYyvdA
  23. Friedrich MG, Sechtem U, Schulz-Menger J, Holmvang G, Alakija P, et al. International Consensus Group on Cardiovascular Magnetic Resonance in Myocarditis, et al. Cardiovascular magnetic resonance in myocarditis: A JACC White Paper. J Am Coll Cardiol. 2009; 53: 1475–1487. Ref.: http://bit.ly/2Yot4Et
  24. Thiene G, Bruneval P, Veinot J, Leone O. Diagnostic use of the endomyocardial biopsy: a consensus statement. Virchows Arch. 2013; 463: 1-5. Ref.: http://bit.ly/2J19LMg
  25. Cooper LT, Baughman KL, Feldman AM, Frustaci A, Jessup M, et al. The role of endomyocardial biopsy in the management of cardiovascular disease. Eur Heart J. 2007; 28: 3076–3093. Ref.: http://bit.ly/2LupzsC
  26. Leone O, Veinot JP, Angelini A, Baandrup UT, Basso C, et al. 2011 consensus statement on endomyocardial biopsy from the Association for European Cardiovascular Pathology and the Society for Cardiovascular Pathology. Cardiovasc Pathol. 2012; 21: 245-274. Ref.: http://bit.ly/2Lt4ej6
  27. Basso C, Calabrese F, Angelini A, Carturan E, Thiene G. Classification and histological, immunohistochemical, and molecular diagnosis of inflammatory myocardial disease. Heart Fail Rev. 2013; 18: 673-681. Ref.: http://bit.ly/303njwl
  28. Thiene G, Bruneval P, Veinot J, Leone O. Diagnostic use of the endomyocardial biopsy: a consensus statement. Virchows Arch. 2013; 463: 1-5. Ref.: http://bit.ly/2J19LMg
  29. Ishibashi-Ueda H, Matsuyama TA, Ohta-Ogo K, Ikeda Y. Significance and Value of Endomyocardial Biopsy Based on Our Own Experience. Circ J. 2017; 24; 81: 417-426. Ref.: http://bit.ly/2Nlyzm5
  30. Kühl U, Pauschinger M, Noutsias M, Seeberg B, Bock T, et al. High prevalence of viral genomes and multiple viral infections in the myocardium of adults with "idiopathic" left ventricular dysfunction. Circulation. 2005; 111: 887-893. Ref.: http://bit.ly/2Lvf9so
  31. Holzmann M, Nicko A, Kühl U, Noutsias M, Poller W, et al. Complication rate of right ventricular endomyocardial biopsy via the femoral approach. Circulation 2008; 118: 1722–1728. Ref.: http://bit.ly/2RPyfL1
  32. Escher F, Lassner D, Kühl U, Gross U, Westermann D, et al. Analysis of Endomyocardial Biopsies in suspected Myocarditis - Diagnostic Value on Left versus Right Ventricular Biopsy. Int J Cardiol. 2014; 177: 76-78. Ref.: http://bit.ly/2YoRptM
  33. Aretz HT. Myocarditis: the Dallas criteria. Hum. Pathol. 1987; 18: 619–624. Ref.: http://bit.ly/2FJ6wHb
  34. Towbin JA, Lowe AM, Colan SD, Sleeper LA, Orav EJ, et al. Incidence, causes, and outcomes of dilated cardiomyopathy in children. JAMA. 2006; 296: 1867-1876. Ref.: http://bit.ly/2FGB8ZF
  35. Bowles NE, Ni J, Kearney DL, Pauschinger M, Schultheiss HP, et al. Detection of viruses in myocardial tissues by polymerase chain reaction. Evidence of adenovirus as a common cause of myocarditis in children and adults. J Am Coll Cardiol. 2003; 42: 466–472. Ref.: http://bit.ly/2KRjqHk
  36. Pauschinger M, Phan MD, Doerner A, Kuehl U, Schwimmbeck PL, et al. Enteroviral RNA replication in the myocardium of patients with left ventricular dysfunction and clinically suspected myocarditis. Circulation. 1999; 99: 889–895. Ref.: http://bit.ly/325qjKj
  37. Kühl U, Rohde M, Lassner D, Gross UM, Escher F, et al. miRNA as activity markers in Parvo B19 associated heart disease. Herz. 2012; 37: 637-643. Ref.: http://bit.ly/2XhbYM9
  38. Kuchynka P, Palecek T, Masek M, Cerny V, Lambert L, et al. Current Diagnostic and Therapeutic Aspects of Eosinophilic Myocarditis. Biomed Res Int. 2016; 2016: 2829583. Ref.: http://bit.ly/322bpVq
  39. Maleszewski JJ, Orellana VM, Hodge DO, Kuhl U, Schultheiss HP, et al. Long-term risk of recurrence, morbidity and mortality in giant cell myocarditis. Am J Cardiol. 2015; 115: 1733-1738. Ref.: http://bit.ly/2J0altr
  40. Larsen BT, Maleszewski JJ, Edwards WD, Cooper LT Jr, Sobonya RE, et al. Atrial giant cell myocarditis: a distinctive clinicopathologic entity. Circulation. 2013; 127: 39-47. Ref.: http://bit.ly/2xpMBIw
  41. Lassner D, Kühl U2, Siegismund CS3, Rohde M3, Elezkurtaj S, et al. Improved diagnosis of idiopathic giant cell myocarditis and cardiac sarcoidosis by myocardial gene expressing profil. Eur Heart J. 2014; 35: 2186-2195. Ref.: http://bit.ly/2KOmaoX
  42. Grogan M, Redfield MM, Bailey KR, Reeder GS, Gersh BJ, et al. Long-term outcome of patients with biopsy-proved myocarditis: comparison with idiopathic dilated cardiomyopathy. J Am Coll Cardiol. 1995; 26: 80-84. Ref.: http://bit.ly/323vgDq
  43. Schultheiss HP, Kühl U. Why is diagnosis of infectious myocarditis such a challenge? Expert Rev Anti Infect Ther. 2011; 9: 1093-1095. Ref.: http://bit.ly/2YuuXzC
  44. Kühl U, Lassner D, von Schlippenbach J, Poller W, Schultheiss HP, et al. Interferon-Beta improves survival in enterovirus-associated cardiomyopathy. J Am Coll Cardiol. 2012; 60: 1295-1296. Ref.: http://bit.ly/31ZqlDy
  45. Verdonschot J, Hazebroek M, Merken J, Debing Y, Dennert R, et al. Relevance of cardiac parvovirus B19 in myocarditis and dilated cardiomyopathy: review of the literature. Eur J Heart Fail. 2016; 18: 1430-1441. Ref.: http://bit.ly/322hDVi
  46. Hjalmarsson C, Liljeqvist JÅ, Lindh M, Karason K, Bollano E, et al. Parvovirus B19 in Endomyocardial Biopsy of Patients With Idiopathic Dilated Cardiomyopathy: Foe or Bystander? J Card Fail. 2019; 25: 60-63. Ref.: http://bit.ly/2Nq3vBP
  47. Verdonschot JAJ, Cooper LT, Heymans SRB. Parvovirus B19 in Dilated Cardiomyopathy: There Is More Than Meets the Eye. J Card Fail. 2019; 25: 64-66. Ref.: http://bit.ly/2YotqLb
  48. Kühl U, Lassner D, Pauschinger M, Gross UM, Seeberg B, et al. Prevalence of erythrovirus genotypes in the myocardium of patients with dilated cardiomyopathy. J Med Virol. 2008; 80: 1243-1251. Ref.: http://bit.ly/2YnP7Lu
  49. Schmidt-Lucke C, Spillmann F, Bock T, Kühl U, Van Linthout S, e al. Interferon beta modulates endothelial damage in patients with cardiac persistence of human parvovirus b19 infection. J Infect Dis. 2010; 201: 936-945. Ref.: http://bit.ly/2XjAaO6
  50. Schmidt-Lucke C, Zobel T, Schrepfer S, Kuhl U, Wang D, et al. Impaired Endothelial Regeneration Through Human Parvovirus B19-Infected Circulating Angiogenic Cells in Patients With Cardiomyopathy. J Infect Dis. 2015; 212: 1070-1081. Ref.: http://bit.ly/2XdkBCK
  51. Kuhl U, Lassner D, Dorner A, Rohde M, Escher F, et al. A distinct subgroup of cardiomyopathy patients characterized by transcriptionally active cardiotropic erythrovirus and altered cardiac gene expression. Basic Res Cardiol. 2013; 108: 372. Ref.: http://bit.ly/2XmaQXN
  52. Escher F, Kühl U, Gross U, Westermann D, Poller W, et al. Aggravation of left ventricular dysfunction in patients with biopsy-proven cardiac human herpesvirus A and B infection. J Clin Virol. 2015; 63: 1-5. Ref.: http://bit.ly/2ZY0ZUL
  53. Pellett PE, Ablashi DV, Ambros PF, Agut H, Caserta MT, et al. Chromosomally integrated human herpesvirus 6: questions and answers. Rev Med Virol. 2012; 22: 144-155. Ref.: http://bit.ly/2Nozkem
  54. Kühl U1, Lassner D, Wallaschek N, Gross UM, Krueger GR, et al. Chromosomally integrated human herpesvirus 6 in heart failure: prevalence and treatment. Eur J Heart Fail. 2015; 17: 9-19. Ref.: http://bit.ly/2xoAyeM
  55. Escher F, Kühl U, Lassner D et al. Presence of Perforin in Endomyocardial Biopsies of Patients with Inflammatory Cardiomyopathy Predicts Poor Outcome. Eur J Heart Fail. 2014; 16: 1066-1072. Ref.: http://bit.ly/2XJ6xVH
  56. Baldeviano GC, Barin JG, Talor MV, Srinivasan S, Bedja D, et al. Interleukin-17A is dispensable for myocarditis but essential for the progression to dilated cardiomyopathy. Circ Res. 2010; 106: 1646-1655. Ref.: http://bit.ly/2JkDkqL
  57. Wu L, Ong S, Talor MV, Barin JG, Baldeviano GC, et al. Cardiac fibroblasts mediate IL-17A-driven inflammatory dilated cardiomyopathy. J Exp Med. 2014; 211: 1449-1464. Ref.: http://bit.ly/2FHTWaY
  58. Myers JM, Cooper LT, Kem DC, Stavrakis S, Kosanke SD, et al. Cardiac myosin-Th17 responses promote heart failure in human myocarditis. JCI Insight. 2016; 1. Ref.: http://bit.ly/325QYqi
  59. Rahmati Z, Amirzargar AA, Saadati S, Rahmani F, Mahmoudi MJ, et al. Association of levels of interleukin 17 and T-helper 17 count with symptom severity and etiology of chronic heart failure: a case-control study. Croat Med J. 2018 31; 59: 139-148. Ref.: http://bit.ly/2XkFctq
  60. Wu L, Diny NL, Ong S, Barin JG, Hou X, et al. Pathogenic IL-23 signaling is required to initiate GM-CSF-driven autoimmune myocarditis in mice. Eur J Immunol. 2016; 46: 582-592. Ref.: http://bit.ly/2Xkalxr
  61. Suthahar N, Meijers WC, Silljé HHW, de Boer RA. From Inflammation to Fibrosis-Molecular and Cellular Mechanisms of Myocardial Tissue Remodelling and Perspectives on Differential Treatment Opportunities. Curr Heart Fail Rep. 2017; 14: 235-250. Ref.: http://bit.ly/2NpphFY
  62. Westermann D, Lindner D, Kasner M, Zietsch C, Savvatis K, et al. Cardiac inflammation contributes to changes in the extracellular matrix in patients with heart failure and normal ejection fraction. Circ Heart Fail. 2011; 4: 44-52. Ref.: http://bit.ly/2Lz9y4F
  63. Piek A, de Boer RA, Silljé HH. The fibrosis-cell death axis in heart failure. Heart Fail Rev. 2016; 21: 199-211. Ref.: http://bit.ly/2FN1gCu
  64. Schultheiss HP, Escher F. The ESC Textbook of Cardiovascular Medicine, Third Edition, 2019. Chapter 32.21: Myocarditis - Treatment of myocarditis.
  65. Hershberger RE, Hedges DJ, Morales A. Dilated cardiomyopathy: the complexity of a diverse genetic architecture. Nat Rev Cardiol. 2013; 10: 531-547. Ref.: http://bit.ly/2FJbDY2
  66. Heymans S, Hirsch E, Anker SD, Aukrust P, Balligand JL, et al. Inflammation as a therapeutic target in heart failure? A scientific statement from the Translational Research Committee of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. 2009; 11: 119-129. Ref.: http://bit.ly/2RQbarQ
  67. Sotiriou E, Heiner S, Jansen T, Brandt M, Schmidt KH, et al. Therapeutic implications of a combined diagnostic workup including endomyocardial biopsy in an all-comer population of patients with heart failure: a retrospective analysis. ESC Heart Fail. 2018; 5: 630-641. Ref.: http://bit.ly/2XAjvVO
  68. Kühl U, Pauschinger M, Schwimmbeck PL, Seeberg B, Lober C, et al. Interferon-beta treatment eliminates cardiotropic viruses and improves left ventricular function in patients with myocardial persistence of viral genomes and left ventricular dysfunction. Circulation. 2003; 107: 2793-2798. Ref.: http://bit.ly/2FIR3H6
  69. Schultheiss HP, Piper C, Sowade O, Waagstein F, Kapp JF, et al. Betaferon in chronic viral cardiomyopathy (BICC) trial: Effects of interferon-β treatment in patients with chronic viral cardiomyopathy. Clin Res Cardiol. 2016; 105: 763-773. Ref.:
  70. Poller W, Kaya Z, Muche M, Kasner M, Skurk C, et al. High incidence of cardiac dysfunction and response to antiviral treatment in patients with chronic hepatitis C virus infection. Clin Res Cardiol. 2017; 106: 551-556. Ref.: http://bit.ly/2XNmg6p
  71. Zobel T, Bock CT, Kühl U, Rohde M, Lassner D, Schultheiss HP, Schmidt-Lucke C. Telbivudine Reduces Parvovirus B19-Induced Apoptosis in Circulating Angiogenic Cells. Viruses. 2019; 11. Ref.: http://bit.ly/300osEJ
  72. Cooper LT. The heat is off: immunosuppression for myocarditis revisited. Eur Heart J. 2009; 30: 1936-1939. Ref.: http://bit.ly/2ZXB7Za
  73. Frustaci A, Russo MA, Chimenti C. Randomized study on the efficacy of immunosuppressive therapy in patients with virus-negative inflammatory cardiomyopathy: the TIMIC study. Eur Heart J. 2009; 30: 1995-2002. Ref.: http://bit.ly/2KQSQy8
  74. Frustaci A, Chimenti C, Calabrese F, Pieroni M, Thiene G, et al. Immunosuppressive therapy for active lymphocytic myocarditis: virological and immunologic profile of responders versus nonresponders. Circulation. 2003; 107: 857-863. Ref.: http://bit.ly/2XgJdzf
  75. Escher F, Kühl U, Lassner D, Poller W, Westermann D, et al. Long-term outcome of patients with virus-negative chronic myocarditis or inflammatory cardiomyopathy after immunosuppressive therapy. Clin Res Cardiol. 2016; 105: 1011-1020. Ref.: http://bit.ly/2XDKHmG
  76. McNamara DM, Holubkov R, Starling RC, Dec GW, Loh E, et al. Controlled trial of intravenous immune globulin in recent-onset dilated cardiomyopathy. Circulation. 2001; 103: 2254-2259. Ref.: http://bit.ly/2FIRJfC
  77. Felix SB, Staudt A, Dörffel WV, Stangl V, Merkel K, et al. Hemodynamic effects of immunoadsorption and subsequent immunoglobulin substitution in dilated cardiomyopathy: three-month results from a randomized study. J Am Coll Cardiol. 2000; 35: 1590-1598. Ref.: http://bit.ly/321yIym
  78. Fan Y, Weifeng W, Yuluan Y, Qing K, Yu P, et al. Treatment with a neutralizing anti-murine interleukin-17 antibody after the onset of coxsackievirus b3-induced viral myocarditis reduces myocardium inflammation. Virol J. 2011; 8: 17. Ref.: http://bit.ly/2YxyrkV
  79. Adegbala O, Olagoke O, Akintoye E, Adejumo AC, Oluwole A, et al. Predictors, Burden, and the Impact of Arrhythmia on Patients Admitted for Acute Myocarditis. Am J Cardiol. 2019; 123: 139-144. Ref.: http://bit.ly/2ZWMsZB
  80. Caforio ALP, Cheng C, Perazzolo Marra M, Tarantini G, Basso C, et al. How to improve therapy in myocarditis: role of cardiovascular magnetic resonance and of endomyocardial biopsy. Eur Heart J Suppl. 2019; 21(Suppl B): B19-B22. Ref.: http://bit.ly/2YxVDiA
  81. Caforio AL, Mahon NJ, Mckenna WJ. Cardiac autoantibodies to myosin and other heart-specific autoantigens in myocarditis and dilated cardiomyopathy. Autoimmunity. 2001; 34: 199-204. Ref.: http://bit.ly/2XeOGBy
  82. Kasner M, Aleksandrov A, Escher F, Al-Saadi N, Makowski M, et al. Multimodality imaging approach in the diagnosis of chronic myocarditis with preserved left ventricular ejection fraction (MCpEF): The role of 2D speckle-tracking echocardiography. Int J Cardiol. 2017; 243: 374-378. Ref.: http://bit.ly/2RLy6IE
  83. Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, et al. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016; 37: 2129-2200. Ref.: http://bit.ly/2J1m4bd
  84. Gorbea C, Makar KA, Pauschinger M, Pratt G, Bersola JL, et al. A role for Toll-like receptor 3 variants in host susceptibility to enteroviral myocarditis and dilated cardiomyopathy. J Biol Chem. 2010; 285: 23208-23223. Ref.: http://bit.ly/2XfsffM
  85. Zimmermann O, Rodewald C, Radermacher M, Vetter M, Wiehe JM, et al. Interferon beta-1b therapy in chronic viral dilated cardiomyopathy--is there a role for specific therapy? J Card Fail. 2010; 16: 348-356. Ref.: http://bit.ly/2XD8pPH
  86. Bachelier K, Biehl S, Schwarz V, Kindermann I, Kandolf R, et al. Parvovirus B19-induced vascular damage in the heart is associated with elevated circulating endothelial microparticles. PLoS One. 2017; 12: e0176311. Ref.: http://bit.ly/2XFMpnt
  87. Kühl U, Rohde M, Lassner D, Gross UM, Escher F, et al. miRNA as activity markers in Parvo B19 associated heart disease. Herz. 2012; 37: 637-643. Ref.: http://bit.ly/2XhbYM9

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