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European Heart Journal Advance Access originally published online on May 5, 2007
European Heart Journal 2007 28(13):1664; doi:10.1093/eurheartj/ehm136
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Myocarditis in hypertrophic cardiomyopathy: reply

Andrea Frustaci

Heart and Great Vessels ‘Attilio Reale’ Department
La Sapienza University
IRCCS L. Spallanzani viale del Policlinico 155
00100 Rome
Italy
‘Molecular and Cellular Cardiology’ Laboratory
National Institute for Infectious Disease
Rome
Italy

Matteo A. Russo

Experimental Medicine Department
La Sapienza University
Rome
Italy

Cristina Chimenti

IRCCS San Raffaele la Pisana
Rome
Italy
IRCCS San Raffaele la Pisana
Rome
Italy

Tel: +39 06 55170575, Fax: +39 06 55170577, E-mail address: biocard{at}inmi.it

We thank Drs Maron and Basso for their comments. The intention of the authors was not to report in their article an additional epidemiological study on hypertrophic cardiomyopathy (HCM) nor to describe a new entity, but an attempt to investigate the possible causes of abrupt disease destabilization, particularly in the context of the same family members where an extremely different outcome is difficult to be explained by genetic reasons.

Thus, the bias selection of HCM patients with acute instability, clearly stated in the discussion section of the article,1 was prompted by the aim to approach those disease manifestations most likely to be clarified by an endomyocardial biopsy study.

With specific regard to myocardial inflammation in HCM, several original pathological studies have reported the observation of inflammatory infiltrates in the context of severely hypertrophied and disorganized cardiomyocytes.2 The recent introduction of advanced techniques, particularly immunohistochemistry for the phenotypic characterization of the inflammatory cells and polymerase chain reaction for the identification of viral genomes, have remarkably improved our ability to diagnose a myocarditic process.3 In contrast, the discouragement to an invasive study of critical patients with HCM may prevent myocarditis to be diagnosed and eventually treated. Actually, various therapeutic strategies are available including antiviral agents as interferon,4 immunosuppression,5 and immunoadsorption procedures6 with potential impact on recovery of cardiac function.

Skepticism toward new observations on unclarified entities risk to be an obstacle to the comprehension of new insights, if not followed by the aim to confirm or disprove them by further studies.

References

  1. Frustaci A, Verardo R, Caldarulo M, Acconcia MC, Russo MA, Chimenti C. Myocarditis in hypertrophic cardiomyopathy patients presenting acute clinical deterioration. Eur Heart J (2007) 28:733–740.[Abstract/Free Full Text]
  2. Lamke GT, Allen RD, Edwards WD, Tazelaar HD, Danielson GK. Surgical pathology of subaortic septal myectomy associated with hypertrophic cardiomyopathy. A study of 204 cases (1996-2000). Cardiovasc Pathol (2003) 12:149–158.[CrossRef][ISI][Medline]
  3. Calabrese F, Thiene G. Myocarditis and inflammatory cardiomyopathy: microbiological and molecular biological aspects. Cardiovasc Res (2003) 60:11–25.[Abstract/Free Full Text]
  4. Kuhl U, Pauschinger M, Schwimmbeck PL, Seeberg B, Lober C, Noutsias M, Poller W, Schultheiss HP. Interferon-beta treatment eliminates cardiotropic viruses and improves left ventricular function in patients with myocardial persistence of viral genomes and left ventricular dysfunction. Circulation (2003) 107:2793–2798.[Abstract/Free Full Text]
  5. Frustaci A, Chimenti C, Calabrese F, Pieroni M, Thiene G, Maseri A. Immunosuppressive therapy for active lymphocytic myocarditis: virological and immunological profile of responders versus nonresponders. Circulation (2003) 107:857–863.[Abstract/Free Full Text]
  6. Staudt A, Schaper F, Stangl V, Plagemann A, Bohm M, Merkel K, Wallukat G, Wernecke KD, Stangl K, Baumann G, Felix SB. Immunohistological changes in dilated cardiomyopathy induced by immunoadsorption therapy and subsequent immunoglobulin substitution. Circulation (2001) 103:2681–2686.[Abstract/Free Full Text]

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This Article
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