Viral Cardiomyopathy: A Review of Clinical Status and Meta-Analysis of Diagnosis and Clinical Management

Abstract

From an aetiological standpoint, viral cardiomyopathy represents an uncommon subtype of non-inflammatory dilated cardiomyopathy. The most common aetiologic agents are enteroviruses, adenoviruses and erythroviruses. Pathogenesis depends on the causative virus. Enteroviruses and adenoviruses infect and injure the cardiomyocyte through cytopathic effect and immune-mediated damage leading to cardiac remodelling, myocarditis and ultimately cardiomyopathy. Erythroviruses infect and injure the vascular endothelial cells resulting in macrovascular dysfunction. Typical clinical presentation is heart failure, arrhythmias and chest pains. Clinical diagnosis requires the presence of electrocardiographic abnormalities, markers of myocardial necrosis or evidence of functional/structural ventricular abnormalities accompanied by at least one physical sign or clinical symptom. However, endomyocardial biopsy remains the reference standard but increased risks of complications and the need for highly experienced operators limits its widespread use. The available clinical management strategies are standard heart failure medication for the management of cardiac dysfunction and antiarrhythmic drugs for those with ventricular arrhythmias. Patients with refractory symptoms greater than six months despite optimal medical therapy and with biopsy-proven virus negative myocardium may benefit from supplementary immunosuppressive therapy. However, largescale and long-term prospective randomized clinical trials are warranted to determine long-term benefits of immunosuppression.

Common pathological findings in the heart in COVID-19-related sudden death cases: An autopsy case series

“…Cardiomyopathy has many causes, including genetic mutations, coronary artery disease, autoimmune disease, alcohol abuse, comorbidities including hypertension and diabetes, and infections [ 7 ]. Viral infection-related cardiomyopathy includes myocarditis, a non-inflammatory dilated cardiomyopathy, and congestive heart failure [ 8 ]. The most common etiologic agents are enteroviruses, adenoviruses, and erythroviruses [ 8 ].…”

“…Viral infection-related cardiomyopathy includes myocarditis, a non-inflammatory dilated cardiomyopathy, and congestive heart failure [ 8 ]. The most common etiologic agents are enteroviruses, adenoviruses, and erythroviruses [ 8 ]. Myocardial infection by SARS-CoV-2 presents various clinical features that are common to the aforementioned pathologies.…”

Colchicine Is a Weapon for Managing the Heart Disease Among Interstitial Lung Disease With Viral Infection: Have We Found the Holy Grail?

“…Cytomegalovirus infection, influenza, and respiratory failure were the main causes for admission based on information provided in the NHIRD (12,13,15). Meanwhile, viral infections such as human immunodeficiency virus, herpes virus, and hepatitis B have been identified as predisposing factors for ILD and viral myocarditis was associated with cardiac arrhythmia, and cardiac failure (15)(16)(17). Therein, viral infection and ILD coexist and interplay, leading to HD.…”

COVID-19: Infection or Autoimmunity

“…The papers using T cell depleting therapies focus on patients presenting with fulminant myocarditis and the use of these therapies is rarely mentioned in clinical reviews of myocarditis except in the treatment of giant cell myocarditis (73)(74)(75)(76). No T cell depleting therapies have ever been part of a randomized prospective trial in myocarditis.…”