12 results on '"Hufnagel G"'
Search Results
2. Dilated cardiomyopathies as a cause of congestive heart failure.
- Author
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Maisch B, Ristić AD, Hufnagel G, Funck R, Alter P, Tontsch D, and Pankuweit S
- Subjects
- Cardiomyopathy, Dilated physiopathology, Cardiomyopathy, Dilated therapy, Heart Failure physiopathology, Heart Failure therapy, Hemodynamics physiology, Humans, Myocardial Contraction physiology, Myocardium pathology, Neurotransmitter Agents physiology, Prognosis, Cardiomyopathy, Dilated diagnosis, Heart Failure diagnosis
- Abstract
Definition and Classification: Cardiomyopathies are disorders affecting the heart muscle that frequently result in congestive heart failure. Five major forms are recognized: dilated, hypertrophic, restrictive, right ventricular, and nonclassifiable cardiomyopathies with distinct hemodynamic properties. Furthermore, the new WHO/WHF definition also comprises inflammatory cardiomyopathy, defined as myocarditis in association with cardiac dysfunction. Idiopathic, autoimmune, and infectious forms of inflammatory cardiomyopathy were recognized. Viral cardiomyopathy is defined as viral persistence in a dilated heart. It may be accompanied by myocardial inflammation and then termed inflammatory viral cardiomyopathy (or viral myocarditis with cardiomegaly). If no inflammation is observed in the biopsy of a dilated heart (< 14 lymphocytes and macrophages/mm2), the term viral cardiomyopathy or viral persistence in dilated cardiomyopathy should be applied., Diagnosis and Treatment: In recent years, there have been breakthroughs in understanding the molecular and genetic mechanisms involved in this group of conditions, enabling improvement of diagnostic strategies and introduction of new therapies. Ongoing evaluation of antiviral, immunoglobulin, and immunosuppressive therapies including the European Study of Epidemiology and Treatment of Cardiac Inflammatory Diseases (ESETCID), removal of antibodies by immunoadsorption, anticytokine and gene therapy, as well as the mechanical support devices may provide new treatment options.
- Published
- 2002
- Full Text
- View/download PDF
3. [Prevention of atrial arrhythmias by pacing].
- Author
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Funck RC, Pomsel K, Grimm W, Hufnagel G, and Maisch B
- Subjects
- Algorithms, Animals, Bradycardia therapy, Clinical Trials as Topic, Electrocardiography, Humans, Randomized Controlled Trials as Topic, Retrospective Studies, Sick Sinus Syndrome therapy, Atrial Fibrillation prevention & control, Atrial Flutter prevention & control, Cardiac Pacing, Artificial methods, Pacemaker, Artificial, Tachycardia prevention & control
- Abstract
Background: Atrial fibrillation is the most frequent arrhythmia. It can impair quality of life considerably. Due to thromboembolic complications it contributes to the patients' morbidity and mortality and to the costs for their medical treatment., Prevention: In chronic atrial fibrillation there is a need for adequate anticoagulation and heart rate control. In paroxysmal and intermittent atrial fibrillation it should be sought to prevent its progression to chronic atrial fibrillation. Since atrial fibrillation initiates negative processes of remodeling within the atrial myocardium, it has the tendency to perpetuate itself. From a theoretical point of view, it can be expected that all means which prevent episodes of atrial fibrillation or which terminate it immediately after its onset, are able to prevent or at least to delay the progression to chronic atrial fibrillation. Pharmacologic treatment is usually used to prevent recurrences of atrial fibrillation. Based on the actual data it can also be expected that pacemakers with special preventive pacing algorithms are able to reduce the atrial arrhythmic burden. Besides consequent overdrive pacing, more sophisticated algorithms like "suppression of premature atrial contractions", "post exercise response", "automatic rest rate" or "post mode-switch pacing" have been developed. They can be applied either alone or in combination with special lead positions (interatrial septal pacing or pacing of the triangle of Koch) or special stimulation configurations like dual site right atrial pacing or biatrial pacing. These pacing strategies cover the most relevant onset mechanisms of atrial fibrillation. Furthermore, there are algorithms to treat atrial tachyarrhythmias actively by antitachycardia pacing (ATP). First clinical results have shown that about 2/3 of the diagnosed atrial tachyarrhythmias could be terminated by these means immediately after their onset., Ongoing Trials: This article gives an overview over the principles of pacing in the management of atrial arrhythmias and ongoing clinical trials in this field. Before a definite judgement on the clinical relevance of these new preventive and therapeutic pacing strategies can be given, the results of these ongoing controlled clinical studies have to be analyzed.
- Published
- 2001
- Full Text
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4. Cytokine activation in pericardial fluids in different forms of pericarditis.
- Author
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Pankuweit S, Wädlich A, Meyer E, Portig I, Hufnagel G, and Maisch B
- Subjects
- Bacterial Infections diagnosis, Bacterial Infections immunology, Bacterial Infections pathology, Biopsy, Diagnosis, Differential, Enzyme-Linked Immunosorbent Assay, Humans, Immunoenzyme Techniques, Inflammation Mediators metabolism, Pericardial Effusion diagnosis, Pericardial Effusion pathology, Pericarditis diagnosis, Pericarditis pathology, Pericardium immunology, Pericardium pathology, Polymerase Chain Reaction, Virus Diseases diagnosis, Virus Diseases immunology, Virus Diseases pathology, Cytokines metabolism, Pericardial Effusion immunology, Pericarditis immunology
- Abstract
There are many causes of pericardial effusion and it is useful to classify them etiologically, since this disorder is the most common pathologic process involving the pericardium. This report details our experience with pericardioscopy and epicardial biopsy in 101 patients with pericardial effusions in whom pericardioscopy was performed. By means of clinical data and polymerase chain reaction we tried to elucidate the etiology of the pericardial effusion which were classified as follows: we found 41 effusions to be induced by primary malignant tumors or tumors metastatic to the pericardium. Specific diagnosis of viral and bacterial pericarditis was established in 17 patients by examination of the pericardial effusion with PCR, where we found 3 patients positive for adenovirus, 5 patients positive for cytomegalovirus, 2 patients positive for enterovirus-RNA and 5 patients positive for borrelia Burgdorferi-DNA. Additionally, idiopathic effusions (lymphocytic and autoreactive) were seen in 35 patients. In summary immunological and molecular biology investigations seem to provide an additional tool in the diagnostic of pericardial effusion with unknown etiology. If we focus on the ELISA results, there is some evidence, that the demonstration [table: see text] of activation markers and soluble mediators of inflammation such as Il-6, Il-8 and IFN-gamma in pericardial effusion and the simultaneously lack of these mediators in sera of the patients first may be helpful in the discrimination of autoreactive and lymphocytic effusion. Second, this cytokine pattern or distribution indicates a possible local inflammatory process, where these cytokines were all released from activated T lymphocytes present in lymphocytic effusion. In the future, this may have therapeutic implications.
- Published
- 2000
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- View/download PDF
5. Arrhythmias in acute pericarditis. An endomyocardial biopsy study.
- Author
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Ristić AD, Maisch B, Hufnagel G, Seferovic PM, Pankuweit S, Ostojic M, Moll R, and Olsen E
- Subjects
- Acute Disease, Adult, Aged, Arrhythmias, Cardiac etiology, Biomarkers analysis, Biopsy, Needle, Diagnosis, Differential, Electrocardiography, Female, Follow-Up Studies, Humans, Male, Middle Aged, Pericarditis etiology, Arrhythmias, Cardiac pathology, Endocardium pathology, Myocardium pathology, Pericarditis pathology
- Abstract
It is still controversial whether the arrhythmias in acute pericarditis are of myocardial or pericardial origin. The aim of the present study was to investigate the occurrence of arrhythmias and conduction disorders in patients with acute pericarditis with no endomyocardial biopsy evidence of myocarditis (group 1: 40 patients, 65% males, mean age 45.6 +/- 15.7 years, mean heart rate [HR] 98.7 +/- 22.2 beats per minute) in comparison to endomyocardial biopsy proven acute myocarditis/perimyocarditis (group 2: 10 patients, 3/10 with perimyocarditis, 70% males, mean age 46.1 +/- 15.8 years, mean heart rate 76.7 +/- 33.1 beats per minute). At the initial assessment all patients underwent comprehensive clinical work-up including echocardiography, cardiac catheterization, and endomyocardial biopsy. In all patients biventricular endomyocardial biopsy was performed using standard femoral approach and Schikumed 7 F or 8 F bioptomes. Tissue samples were stained by H & E, v. Gieson and independently reviewed by two cardiac pathologists. In addition immunohistochemistry and immunocytochemistry were performed, and only patients fulfilling Dallas and World Heart Federation criteria were selected for group 2. Comparative analysis of electrocardiograms and 24-hour Holter recordings at initial presentation revealed in group 1 vs group 2 significantly less frequent paroxysmal supraventricular tachyarrhythmias (5% vs 40%), and ventricular fibrillation (0 vs 20%), in contrast to atrial fibrillation that occurred more often (20% vs 0) (all p < 0.05). Furthermore, in the group 2 one patient died due to VF and two patients underwent ICD implantation. Low voltage (40% vs 30%) and ST/T wave changes (47.5% vs 30%), as well as the incidence of the II degree AV block (5% vs 0) and complete AV block (2.5% vs 10%) were not significantly different between the groups. In conclusion, patients with pericarditis and no endomyocardial biopsy indications of myocarditis had significantly less often life threatening rhythm disorders in contrast to patients with endomyocardial biopsy proven acute myocarditis/perimyocarditis. On the contrary, incidence of transitory atrial fibrillation was higher in acute pericarditis, than in myocarditis.
- Published
- 2000
- Full Text
- View/download PDF
6. The European Study of Epidemiology and Treatment of Cardiac Inflammatory Diseases (ESETCID). First epidemiological results.
- Author
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Hufnagel G, Pankuweit S, Richter A, Schönian U, and Maisch B
- Subjects
- Cardiomyopathies drug therapy, Cardiomyopathies etiology, Chronic Disease, Cross-Sectional Studies, Double-Blind Method, Europe epidemiology, Humans, Immunization, Passive, Immunoglobulin A therapeutic use, Immunoglobulin M therapeutic use, Immunoglobulins, Immunoglobulins, Intravenous, Incidence, Interferon-alpha therapeutic use, Myocarditis drug therapy, Myocarditis etiology, Prednisolone therapeutic use, Prospective Studies, Virus Diseases diagnosis, Virus Diseases drug therapy, Virus Diseases epidemiology, Cardiomyopathies epidemiology, Myocarditis epidemiology
- Abstract
By including immunohistochemical parameters the WHF Task Force for the Definition of Acute and Chronic Myocarditis expanded the light microscopical Dallas criteria of myocarditis. The rapid development of new molecular biological techniques such as polymerase chain reaction (PCR) and in-situ hybridization has improved our understanding of the underlying etiological and pathophysiological mechanisms in inflammatory heart disease. Treatment of dilated cardiomyopathy with inflammation is still controversial, however. The American Myocarditis Treatment Trial could not demonstrate a significant difference in the improvement of ejection fraction between patients with active myocarditis in the cyclosporine/prednisolone treated group when compared to placebo. In the European Study of Epidemiology and Treatment of Inflammatory Heart Disease (ESETCID) patients with acute or chronic myocarditis are treated specifically according to the etiology of the disease. Patients are screened not only for infiltrating cells, but also for the presence of persisting viral genome (enterovirus, cytomegalovirus and adenovirus). By investigating endomyocardial biopsies of 3,055 patients ongoing inflammatory processes in the heart could be found in 17.2%. Only 182 showed a reduced ejection fraction below 45% fulfilling the entrance criteria for the ESETCID trial. These data imply that in symptomatic patients inflammatory heart muscle disease has to be considered regardless of left ventricular function and that endomyocardial biopsy can be an important tool for diagnosis. Virus could be detected in 11.8% (enterovirus 2.2%, cytomegalovirus 5.4%, adenovirus 4.2%). These first epidemiological results of this prospective randomized study demonstrate that viral persistence may contribute to the pathogenesis of inflammatory heart muscle disease, and that in chronic myocarditis viral persistence occurs in a smaller percentage of patients compared to previously published studies which were performed on highly selected patients.
- Published
- 2000
- Full Text
- View/download PDF
7. Definition of inflammatory cardiomyopathy (myocarditis): on the way to consensus. A status report.
- Author
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Maisch B, Portig I, Ristic A, Hufnagel G, and Pankuweit S
- Subjects
- Autoantibodies analysis, Cardiomyopathy, Dilated immunology, Cardiomyopathy, Dilated pathology, Chronic Disease, Endocardium immunology, Endocardium pathology, Humans, Leukocyte Count, Myocarditis immunology, Myocarditis pathology, Myocardium immunology, Myocardium pathology, Virus Diseases diagnosis, Virus Diseases immunology, Virus Diseases pathology, Cardiomyopathy, Dilated diagnosis, Myocarditis diagnosis
- Abstract
This article reviews the current state of consensus reached for the diagnosis of myocarditis and dilated cardiomyopathy on the basis of conventional histopathological and immunohistochemical methods for inflammatory infiltrates in addition to molecular biological methods for persistence of viral genome in endomyocardial biopsies. Additionally, a brief overview is presented stating the current knowledge on effector mechanisms of the immune system in myocarditis and dilated cardiomyopathy.
- Published
- 2000
- Full Text
- View/download PDF
8. Prevalence of viral genome in endomyocardial biopsies from patients with inflammatory heart muscle disease.
- Author
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Pankuweit S, Portig I, Eckhardt H, Crombach M, Hufnagel G, and Maisch B
- Subjects
- Adenovirus Infections, Human epidemiology, Adenovirus Infections, Human pathology, Biopsy, Cardiomyopathy, Dilated epidemiology, Cardiomyopathy, Dilated pathology, Cross-Sectional Studies, Cytomegalovirus Infections epidemiology, Cytomegalovirus Infections pathology, DNA, Viral analysis, Endocardium pathology, Endocardium virology, Enterovirus Infections epidemiology, Enterovirus Infections pathology, Humans, Incidence, Myocarditis epidemiology, Myocarditis pathology, Myocardium pathology, Polymerase Chain Reaction, RNA, Viral analysis, Adenovirus Infections, Human virology, Cardiomyopathy, Dilated virology, Cytomegalovirus Infections virology, Enterovirus Infections virology, Genes, Viral, Myocarditis virology
- Abstract
In the report of the 1995 World Health Federation/International Society and Federation of Cardiology (WHF/ISFC) Task Force on the Definition and Classification of Cardiomyopathies, the definition of heart muscle diseases was updated. Idiopathic, autoimmune, and infectious forms of inflammatory cardiomyopathy are now recognized in this definition. Enteroviruses, adenoviruses and cytomegaloviruses are considered as main etiopathological factors in the pathogenesis of inflammatory heart disease. A wide range of different assays have been and are currently being used, either alone or in combination, to assay for the presence of enteroviral RNA and/or DNA of cytomegalo- and adenoviruses in endomyocardial biopsy and explanted heart samples. The prevalence of cardiotropic viruses in endomyocardial biopsies of patients with clinically suspected inflammatory cardiomyopathy varies widely: enteroviral genome was detected in endomyocardial biopsies of 3 to 53% of patients, cytomegaloviral DNA was detected in 3 to 40% of patients with inflammatory heart disease and adenoviruses in 3 to 23% of the patients. This report summarizes the methods that have been used and the results of molecular biological investigation with polymerase chain reaction, which were reported by several groups over the last years. Taking this together it seems to be clear that the improvement of molecular biological techniques and the experience of people working with these methods will lead to more reliable results on prevalence, persistence and the diagnostic value of these investigations. These findings have to be taken into account in future diagnostic and therapeutic studies in the field of cardiomyopathies.
- Published
- 2000
- Full Text
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9. [Cell death in inflammatory heart muscle diseases--apoptosis or necrosis?].
- Author
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Pankuweit S, Jobmann M, Crombach M, Portig I, Alter P, Kruse T, Hufnagel G, and Maisch B
- Subjects
- Animals, Humans, In Situ Nick-End Labeling, Necrosis, Apoptosis physiology, Cardiomyopathies pathology, Cell Death physiology, Myocardial Infarction pathology, Myocarditis pathology, Myocardium pathology
- Abstract
Cell death can be induced by 2 different mechanisms: necrosis and apoptosis. Necrosis, on the one hand, is usually caused by unphysiological stress factors such as hyperthermia or hypoxia, apoptosis, on the other hand, is part of the normal organ development and controls for example immune responses. Morphologically, necrosis is characterized by swelling of cells and their organelles leading to the disruption of the cell membrane, which in turn causes an inflammatory reaction in the surrounding tissue. Morphological and biochemical criteria (Figure 1, Table 1) of apoptosis are the condensation of chromatin leading to the development of apoptotic bodies or membrane-enclosed vesicles containing oligonucleosomal DNA fragments. Important diagnostic tools of cell death (Table 2), such as the TUNEL test (Figure 2) or gel electrophoresis of extracted DNA (Figure 3) are based on the above mentioned biochemical characteristics, but a reliable differentiation of apoptotic versus necrotic processes is not always possible. Experimental studies in animals and studies in various diseases of the cardiovascular system were able to show that apoptosis in myocytes can be induced, an issue that has long been discussed controversially. Ischemia, reperfusion, and myocardial infarction were also shown to lead to apoptosis in cardiomyocytes, whereas cell destruction was caused mainly by necrosis. Several authors (Table 3) demonstrated apoptotic indices in cardiomyocytes of patients with dilatated cardiomyopathy, arrhythmogenic right ventricular cardiomyopathy and patients with acute infarction from 0.25 to 35% by the use of the TUNEL test. Others were able to demonstrate an elevated expression of Fas-receptor in cells of atheroslerotic plaques in patients with atherosclerosis and high indices of apoptotic cardiomyocytes in patients with chronic heart failure. We investigated endomyocardial biopsies of patients with inflammatory cardiomyopathy, DCM without inflammatory reaction but the presence of adenoviral or cytomegaloviral genome and idiopathic DCM using the TUNEL test. The percentage of apoptotic cardiomyocytes in biopsies of patients with DCMi was 1.03 and in biopsies of patients with adenoviral genome 0.25, whereas in all other groups no apoptosis was found. If apoptosis plays a major role in myocardial diseases such as heart failure, arrhythmia and others, blocking this mechanism will have to be considered as a therapeutical strategy. Therefore, studies on the extent of apoptotic processes in diseased versus healthy cardiac tissue are of great importance.
- Published
- 1999
- Full Text
- View/download PDF
10. [Cytomegalovirus and herpes simplex virus in pathogenesis and progression of native arteriosclerosis and recurrent stenosis after intervention].
- Author
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Herzum M, Schaefer JR, Hufnagel G, and Maisch B
- Subjects
- Animals, Arteriosclerosis pathology, Coronary Artery Disease pathology, Cytomegalovirus Infections pathology, Endothelium, Vascular pathology, Endothelium, Vascular virology, Female, Herpes Simplex pathology, Humans, Male, Recurrence, Risk Factors, Virulence, Angioplasty, Balloon, Coronary, Arteriosclerosis virology, Coronary Artery Disease virology, Cytomegalovirus pathogenicity, Cytomegalovirus Infections virology, Herpes Simplex virology, Simplexvirus pathogenicity
- Abstract
An increasing number of clinical and experimental studies point to a contribution of various infectious organisms like chlamydia pneumoniae or herpesviruses to atherosclerosis in man. Cytomegalovirus induces atherosclerotic lesions in animals. In vitro studies reveal functional changes of endothelial cells after infection with cytomegalovirus. Infection with this virus renders endothelial cells immunogenic for cellular and humoral immune reactions. In man a significant association of infections with herpesviruses and atherosclerosis could be established in several studies. Cytomegalovirus infection has been incriminated as an independent risk factor in restenosis after coronary angioplasty.
- Published
- 1998
- Full Text
- View/download PDF
11. [The extracellular matrix and cytoskeleton of the myocardium in cardiac inflammatory reaction].
- Author
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Wilke A, Schönian U, Herzum M, Hengstenberg C, Hufnagel G, Brilla CG, and Maisch B
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- Autoantibodies analysis, Cytoskeleton immunology, Endocarditis, Bacterial immunology, Endocarditis, Bacterial pathology, Extracellular Matrix immunology, Graft Rejection immunology, Graft Rejection pathology, Heart Transplantation immunology, Heart Transplantation pathology, Humans, Inflammation Mediators metabolism, Myocarditis immunology, Myocardium immunology, Cytoskeleton pathology, Extracellular Matrix pathology, Myocarditis pathology, Myocardium pathology
- Abstract
The cardiac cytoskeleton and the extracellular matrix play an essential role for maintaining cellular integrity and function of the myocardium. The network of microtubules and intermediate filaments are disrupted by the inflammatory reaction which depends on resident cells (myocytes, fibroblasts, endothel cells) and on systemic cells (granulocytes, macrophages, monocytes, lymphocytes). Changes in the cardiac cytoskeleton and the extracellular matrix may affect contractile function, since the cytoskeleton organizes the intra- and intercellular architecture. The inflammation in heart disease and the induction of fibrosis are mediated by cytokines and growth factors derived from fibroblast activation and from the B- and T-cell activity. A possible connecting link for the induction of fibrosis is the presentation of the myocardial antigens to the immune system and its subsequent cellular and humoral autoreactive response (Figure 1). Different autoantibodies to sarcolemmal and myolemmal antigens, to laminin, to extracellular matrix proteins, to the collagens and to myofibrils were demonstrated both in endomyocardial biopsy and as circulating autoantibodies in the peripheral blood. The pathophysiological role of the cytoskeleton and the extracellular matrix are well defined for beta-tubulin, fibronectin, laminin, desmin, vimentin, vinculin and collagen: beta-tubulin is increased or altered in dilated cardiomyopathy (DCM). Fibronectin appears in irregular forms in DCM as well. Ultrastructural analysis showed an increased content of laminin in basement membranes. In addition anti-laminin antibodies were found in 73% of patients with myocarditis and in 78% of patients with DCM. Desmin (z-bands) are partly destroyed in DCM. Anti-desmin antibody titers as indicators of a possible secondary immune response are found high in patients with acute myocarditis declining during reconvalescence and are also elevated in DCM. The vimentin of the endothelial cells and the vinculin of the sarcolemmal membrane and the intercalated discs have been demonstrated to be irregularly shaped and increased in content in DCM whereas in myocarditis their appearance and content is still unknown. The intracellular content of collagen type 5 is increased in DCM and in myocarditis. The presence of autoantibodies to components of the cytoskeleton and the extracellular matrix in myocarditis and perimyocarditis is well-described. Antibodies to the myolemma and the sarcolemma are found in almost all patients with perimyocarditis in the serum or bound in the biopsy. Some of them have been known cytolytic in vitro to isolated heart cells. In pericarditis a shift to antibodies to the extracellular matrix, collagen and intermediate filaments is observed among the circulating antibodies.(ABSTRACT TRUNCATED AT 400 WORDS)
- Published
- 1995
12. Interesting problems in enteroviral inflammatory heart disease.
- Author
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Tracy S, Hufnagel G, and Chapman N
- Subjects
- Animals, Cells, Cultured, Coxsackievirus Infections immunology, Coxsackievirus Infections microbiology, Enterovirus isolation & purification, Enterovirus pathogenicity, Enterovirus B, Human isolation & purification, Enterovirus B, Human pathogenicity, Epitopes, Humans, Mice, Myocarditis immunology, Myocarditis microbiology, T-Lymphocytes immunology, Time Factors, Virulence, Enterovirus Infections immunology, Enterovirus Infections microbiology, Myocarditis etiology
- Abstract
Enteroviral inflammatory heart disease is an established entity. Based upon the accumulated work from many laboratories, specific and definitive questions can be posed regarding the pathogenic nature of the viruses involved and how the host immune systems respond to the insult of enterovirus replication in the myocardium. The answers to these questions may well lead to efficient intervention therapies such as vaccination or effective anti-viral compounds, thus eradicating enterovirus-induced heart disease. Understanding the nature of the acute disease is the first requirement toward a complete understanding of the mechanisms at work in chronic inflammatory heart disease.
- Published
- 1992
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