Possibility of a new infective aetiological agent in congestive cardiomyopathy

Myocardial remodeling in viral heart disease: possible interactions between inflammatory mediators and MMP-TIMP system

Matrix metalloproteinases (MMP), a family of proteases, are involved in the degradation of extracellular matrix proteins and hence in the determination of interstitial architecture. In the heart, MMPs have been found to play a significant role in the development of myocardial remodeling and congestive heart failure. Tissue inhibitors of matrix metalloproteinases (TIMPs) represent a family of proteins which are known to regulate the expression and activity of MMPs. TIMPs are endogenous physiological inhibitors of MMPs and their concomitant downregulation in heart failure suggests the existence of a critical balance between MMPs and TIMPs in the normal maintenance of myocardial interstitial homeostasis. In addition, cytokines regulate expression of both MMPs and TIMPs besides eliciting a direct effect on myocardial cell function. Therefore, myocardial inflammation may also contribute to the development of cardiac remodeling along with other stimuli like mechanical stress and humoral factors. Viral myocarditis, a predisposing factor for dilated cardiomyopathy, is a condition in which extent of intramyocardial inflammation is thought to determine the progression of disease. Inflammatory events in the heart following viral infection are speculated to be responsible for the transition of myocarditis to dilated cardiomyopathy. In viral myocarditis and other inflammatory heart diseases, the inflammatory cells and their battery of cytokines may also alter the myocardial MMP-TIMP system and eventually lead to dilation of the heart and ventricular dysfunction. The objective of this review is to present an overall picture of the inflammatory phase in viral myocarditis and discuss the possible interactions between inflammation and myocardial MMP profiles which may lead to the evolution of dilated cardiomyopathy.

Immunomodulatory treatment strategies in inflammatory cardiomyopathy: current status and future perspectives

Chronic autoimmunity and viral persistence constitute prognostic factors for adverse outcome in dilated cardiomyopathy patients. Inflammatory cardiomyopathy is a specific cardiomyopathy entity diagnosed in approximately 50% of dilated cardiopmyopathy patients by immunohistological quantification of immunocompetent infiltrates and cell adhesion molecule abundance. Patients with autoimmune inflammatory cardiomyopathy benefit from immunosuppressive treatment and immunoadsorption by improvement of left ventricular ejection fraction and heart failure symptoms, paralleled by a significant suppression of intramyocardial inflammation. However, dilated cardiomyopathy patients with viral persistence do not respond favorably to immunosuppression.

Increased myosin orientation during muscle contraction: a measure of cardiac contractility

Myosin form birefringence has been studied in cryostat sections of left ventricular myocardium from the dog and human. The muscle in such sections has been shown to demonstrate the sliding filament phenomenon. The sarcomere length of canine myocardium agreed with that found in comparable electron micrographs. Unexpectedly, it was found that glycerol, normally used as an inert and optically ideal mountant, caused profound change in myosin birefringence. This apparently invalidates results obtained with this mountant. The absolute birefringence found in these sections, whether mounted in glycerol or in an ATP-calcium buffer, corresponded to values found by other workers with skeletal muscle and isolated myosin. However, the birefringent properties (optical path difference: o.p.d.) of well functioning muscle was found to be low, the o.p.d. increasing when exposed to ATP and calcium. Poorly functioning muscle could be distinguished from well functioning muscle on the basis of its higher 'in air' o.p.d. This difference correlated well with physiological assessments of myocardial function or with clinical assessments of cardiac failure. Evidence is presented indicating that changes in apparent birefringence, caused by ATP-calcium or by anoxia, are due to altered orientation of the myosin micelles and can be inhibited by agents that inhibit myosin ATPase activity.

Diagnostic relevance of humoral and cytotoxic immune reactions in primary and secondary dilated cardiomyopathy

Circulating muscle-specific antimyolemmal antibodies (AMLAs) were found in 18 of 61 patients with secondary dilated cardiomyopathy (DC). All 18 patients had clinical or histologic evidence of previous perimyocarditis. AMLAs were found both in patients' serum samples and bound to the sarcolemmal sheath of the autologous myocardial biopsy specimen. Only AMLAs in postmyocardiac DC induced cytolysis of vital cardiocytes in the presence of complement, whereas hepatocytes remained unaffected. Titers of AMLAs correlated with the degree of cardiocytolysis. In contrast, antiinterfibrillary antibodies were found in 49% patients with primary DC (n = 79) and in 61% of patients (n = 30) with alcoholic DC. The incidence of antifibrillary antibodies of the antimyosin type was 23 and 24%, respectively. Incidence of both antibodies increased according to the severity assessed by New York Heart Association functional classes. Circulating immune complexes assayed by a new Clq-solid phase fluorometric assay were present in 30% of patients with postmyocarditic DC only. Lymphocyte-mediated cytotoxicity against heterologous cardiac target cells (K-cell activity) was measured in 33% of patients each with primary and secondary alcoholic DC but not postmyocarditic DC. There were no blocking factors in primary but were some in alcoholic heart disease.

The frontiers of cardiomyopathy

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Pathology of primary cardiomyopathies

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Radiological aspects of heart muscle disease in Nigerian adults

A congestive cardiomyopathy, known locally as heart muscle disease, accounts for 32% of the cases of cardiovascular disease seen at University College Hospital, Ibadan, Nigeria.

Following a brief outline of the clinical picture and necropsy findings, the radiological features of the disease are described. Thirty-four cases were studied, and angiography was performed in 13. In the acute stage of the disease there was a generalized, globular, cardiac enlargement, and cardiac movements, especially of the left border of the heart, were reduced. Pulmonary venous congestion was invariably present and pleural effusions occurred frequently. Ventricular angiography demonstrated an enlarged chamber with little change in size and shape throughout the cardiac cycle, and persistence of contrast. Mitral incompetence was present in some cases. The value of angiography in differential diagnosis in emphasized.