The European study of Epidemiology and Treatment of Cardiac Inflammatory Diseases (ESETCID) - First epidemiological results

By including immunohistochemical parameters the WHF Task Force for the Defi nition of Acute and Chronic Myocarditis expanded the light microscopical Da llas criteria of myocarditis. The rapid development of new molecular biolog ical techniques such as polymerase chain reaction (PCR) and insitu hybridiz ation has improved our understanding of the underlying etiological and path ophysiological mechanisms in inflammatory heart disease. Treatment of dilat ed cardiomyopathy with inflammation is still controversial, however. The Am erican Myocarditis Treatment Trial could not demonstrate a significant diff erence in the improvement of ejection fraction between patients with active myocarditis in the cyclosporine/prednisolone treated group when compared t o placebo. In the European Study of Epidemiology and Treatment of Inflammatory Heart D isease (ESETCID) patients with acute or chronic myocarditis are treated spe cifically according to the etiology of the disease. Patients are screened n ot only for infiltrating cells, but also for the presence of persisting vir al genome (enterovirus, cytomegalovirus and adenovirus). By investigating e ndomyocardial biopsies of 3,055 patients ongoing inflammatory processes in the heart could be found in 17.2%. Only 182 showed a reduced ejection fract ion 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 endom yocardial biopsy can be an important tool for diagnosis. Virus could be det ected in 11.8% (enterovirus 2.2%, cytomegalovirus 5.4%, adenovirus 4.2%). These first epidemiological results of this prospective randomized study de monstrate that viral persistence may contribute to the pathogenesis of infl ammatory heart muscle disease, and that in chronic myocarditis viral persis tence occurs in a smaller percentage of patients compared to previously pub lished studies which were performed on highly selected patients.