A clinical trial of immunosuppressive therapy for myocarditis. The Myocarditis Treatment Trial Investigators
J. W. Mason, J. B. O'Connell, A. Herskowitz, N. R. Rose, B. M. McManus, M. E. Billingham, T. E. Moon; Myocarditis Treatment Trial Investigators

This paper is of particular importance because it is the largest randomized controlled trial of immunosuppressive therapy in patients with myocarditis. The Myocarditis Treatment Trial was a multicenter clinical trial conducted to determine the efficacy of immunosuppressive therapy for treatment of biopsy-documented myocarditis...

High prevalence of viral genomes and multiple viral infections in the myocardium of adults with “idiopathic” left ventricular dysfunction
U. Kühl, M. Pauschinger, M. Noutsias, B. Seeberg, T. Bock, D. Lassner, W. Poller, R. Kandolf, H.-P. Schultheiss

Viruses are important pathogenic agents in acute myocarditis and have been associated with the development of dilated cardiomyopathy. Enteroviruses have long been considered to be the most important viral pathogen in this disease, but, more recently, other viruses have been implicated as well...

The role of endomyocardial biopsy in the management of cardiovascular disease
L. T. Cooper, K. L. Baughman, A. M. Feldman, A. Frustaci, M. Jessup, U. Kühl, G. N. Levine, J. Narula, R. C. Starling, J. Towbin, R. Virmani; American Heart Association; American College of Cardiology; European Society of Cardiology; Heart Failure Society of America; Heart Failure Association of the European Society of Cardiology

The role of endomyocardial biopsy (EMB) in the diagnosis and treatment of cardiovascular disease is controversial. Who is an appropriate candidate for EMB?...

Controlled trial of intravenous immune globulin in recent-onset dilated cardiomyopathy (IMAC-1)
D. M. McNamara, R. Holubkov, R. C. Starling, G. W. Dec, E. Loh, G. Torre-Amione, A. Gass, K. Janosko, T. Tokarczyk, P. Kessler, D. L. Mann, A. M. Feldman; Intervention in Myocarditis and Acute Cardiomyopathy (IMAC) Investigators

The relationship between myocarditis and idiopathic dilated cardiomyopathy remains elusive, and both viral and autoimmune pathogenic mechanisms continue to be investigated. High dose intravenous immune globulin (IVIG) has both antiviral and immune modulatory effects and has been used to successfully treat children with new-onset dilated cardiomyopathy and myocarditis in children...

Long-term outcome of fulminant myocarditis as compared with acute (nonfulminant) myocarditis
R. E. McCarthy III, J. P. Boehmer, R. H. Hruban, G. M. Hutchins, E. K. Kasper, J. M. Hare, K. L. Baughman

Patients with lymphocytic myocarditis have a clinical course that varies greatly. Those with subclinical disease may be asymptomatic, while those with fulminant disease present with severe hemodynamic compromise that not infrequently leads to death...

Diagnostic performance of cardiovascular magnetic resonance in patients with suspected acute myocarditis: comparison of different approaches
H. Abdel-Aty, P. Boyé, A. Zagrosek, R. Wassmuth, A. Kumar, D. Messroghli, P. Bock, R. Dietz, M.G. Friedrich, J. Schulz-Menger

Diagnosing acute myocarditis remains challenging, as patients present with a wide array of symptoms that often mimic other disorders. Cardiovascular magnetic resonance imaging (CMR) has become an important tool to help confirm this diagnosis...

Idiopathic giant-cell myocarditis—natural history and treatment. Multicenter Giant Cell Myocarditis Study Group Investigators
L. T. Cooper Jr, G. J. Berry, R. Shabetai; Multicenter Giant Cell Myocarditis Study Group Investigators

Idiopathic giant cell myocarditis (GCM), is a unique entity that is quite rare and has an extremely poor prognosis. This paper is a landmark study in the field of myocarditis because it outlines the natural history and effect of treatment in patients with this disease. Information on potential study participants was solicited through study announcements in several leading cardiovascular journals published in the United States as well as through direct mailings to the directors of US heart transplantation centers participating in the United Network for Organ Sharing and to major cardiovascular centers worldwide...

A prospective study of biopsy-proven myocarditis: prognostic relevance of clinical and aetiopathogenetic features at diagnosis
A. L. P. Caforio, F. Calabrese, A. Angelini, F. Tona, A. Vinci, S. Bottaro, A. Ramondo, E. Carturan, S. Iliceto, G. Thiene, L. Daliento

Despite advances in immunology and virology, establishing the etiopathogenetic features of myocarditis remains a challenging task. Patients present with a broad spectrum of histologic and serologic features that can make it difficult to manage these patients, particularly with regard to treatment and prognosis...

Autoimmunity in Coxsackievirus infection
N. R. Rose

Viral myocarditis is an entity characterized by a complex interplay between virus-triggered innate and adaptive immune responses resulting in pathogenic autoimmunity...

Complication rate of right ventricular endomyocardial biopsy via the femoral approach: a retrospective and prospective study analyzing 3048 diagnostic procedures over an 11-year period
M. Holzmann, A. Nicko, U. Kühl, M. Noutsias, W. Poller, W. Hoffmann, A. Morguet, B. Witzenbichler, C. Tschöpe, H.-P. Schultheiss, M. Pauschinger

Right ventricular endomyocardial biopsy (EMB) is widely used as a diagnostic tool for assessing patients with known or suspected cardiomyopathies. It remains the gold standard for confirming the diagnosis of myocarditis and ascertaining myocardial viral persistence...