循環器ジャーナル71巻2号

2023年04月発行

特集 今だからこそ聞きたい心不全診療のこと。 Ⅰ．病態

inflammatory DCMの心筋炎症は果たして治療標的になるのか？

著者： 多田篤司¹ 永井利幸¹

所属機関： ¹北海道大学大学院医学研究院循環病態内科学

ページ範囲：P.196 - P.204

POINT
・inflammatory DCMの病態は，心筋の活動性炎症により生じた心筋組織の傷害や線維化と考えられている．
・inflammatory DCMの診断と予後層別には，心筋病理組織における炎症細胞浸潤の評価が有用である．
・inflammatory DCMに対する治療に関しては，心筋の炎症を標的としたものが報告されているが，エビデンスは乏しい．

参考文献

1）Caforio AL, Pankuweit S, Arbustini E, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis : a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J 2013 ; 34 : 2636-2648, 2648a-2648d.

2）Verdonschot J, Hazebroek M, Merken J, et al. Relevance of cardiac parvovirus B19 in myocarditis and dilated cardiomyopathy : review of the literature. Eur J Heart Fail 2016 ; 18 : 1430-41.

3）Tschope C, Ammirati E, Bozkurt B, et al. Myocarditis and inflammatory cardiomyopathy : current evidence and future directions. Nat Rev Cardiol 2021 ; 18 : 169-93.

4）Rose NR. Learning from myocarditis : mimicry, chaos and black holes. F1000Prime Rep 2014 ; 6 : 25.

5）Baughman KL. Diagnosis of myocarditis : death of Dallas criteria. Circulation 2006 ; 113 : 593-5.

6）Maisch B, Portig I, Ristic A, et al. Definition of inflammatory cardiomyopathy（myocarditis） : on the way to consensus. A status report. Herz 2000 ; 25 : 200-9.

7）Katzmann JL, Schlattmann P, Rigopoulos AG, et al. Meta-analysis on the immunohistological detection of inflammatory cardiomyopathy in endomyocardial biopsies. Heart Fail Rev 2020 ; 25 : 277-94.

8）Ohta-Ogo K, Sugano Y, Ogata S, et al. Myocardial T-Lymphocytes as a Prognostic Risk-Stratifying Marker of Dilated Cardiomyopathy-Results of the Multicenter Registry to Investigate Inflammatory Cell Infiltration in Dilated Cardiomyopathy in Tissues of Endomyocardial Biopsy（INDICATE Study）. Circ J 2022 ; 86 : 1092-101.

9）Kodama M, Oda H, Okabe M, et al. Early and long-term mortality of the clinical subtypes of myocarditis. Jpn Circ J 2001 ; 65 : 961-4.

10）Heymans S, Eriksson U, Lehtonen J, et al. The Quest for New Approaches in Myocarditis and Inflammatory Cardiomyopathy. J Am Coll Cardiol 2016 ; 68 : 2348-64.

11）Grun S, Schumm J, Greulich S, et al. Long-term follow-up of biopsy-proven viral myocarditis : predictors of mortality and incomplete recovery. J Am Coll Cardiol 2012 ; 59 : 1604-15.

12）Mason JW, O'Connell JB, Herskowitz A, et al. A clinical trial of immunosuppressive therapy for myocarditis. The Myocarditis Treatment Trial Investigators. N Engl J Med 1995 ; 333 : 269-75.

13）Frustaci A, Chimenti C, Calabrese F, et al. Immunosuppressive therapy for active lymphocytic myocarditis : virological and immunologic profile of responders versus nonresponders. Circulation 2003 ; 107 : 857-63.

14）Parrillo JE, Cunnion RE, Epstein SE, et al. A prospective, randomized, controlled trial of prednisone for dilated cardiomyopathy. N Engl J Med 1989 ; 321 : 1061-8.

15）Wojnicz R, Nowalany-Kozielska E, Wojciechowska C, et al. Randomized, placebo-controlled study for immunosuppressive treatment of inflammatory dilated cardiomyopathy : two-year follow-up results. Circulation 2001 ; 104 : 39-45.

16）Frustaci A, Russo MA, Chimenti C. Randomized study on the efficacy of immunosuppressive therapy in patients with virus-negative inflammatory cardiomyopathy : the TIMIC study. Eur Heart J 2009 ; 30 : 1995-2002.

17）Merken J, Hazebroek M, Van Paassen P, et al. Immunosuppressive Therapy Improves Both Short-and Long-Term Prognosis in Patients With Virus-Negative Nonfulminant Inflammatory Cardiomyopathy. Circ Heart Fail 2018 ; 11 : e004228.

18）Shioji K, Kishimoto C, Sasayama S. Fc receptor-mediated inhibitory effect of immunoglobulin therapy on autoimmune giant cell myocarditis : concomitant suppression of the expression of dendritic cells. Circ Res 2001 ; 89 : 540-6.

19）Hazebroek MR, Henkens M, Raafs AG, et al. Intravenous immunoglobulin therapy in adult patients with idiopathic chronic cardiomyopathy and cardiac parvovirus B19 persistence : a prospective, double-blind, randomized, placebo-controlled clinical trial. Eur J Heart Fail 2021 ; 23 : 302-9.

20）Rodriguez A, Alvarez-Rocha L, Sirvent JM, et al. ［Recommendations of the Infectious Diseases Work Group（GTEI）of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units（SEMICYUC）and the Infections in Critically Ill Patients Study Group（GEIPC）of the Spanish Society of Infectious Diseases and Clinical Microbiology（SEIMC）for the diagnosis and treatment of influenza A/H1N1 in seriously ill adults admitted to the Intensive Care Unit］. Med Intensiva 2012 ; 36 : 103-37.