Language：English   Publisher：The Japanese Circulation Society  

<p>Myocarditis is a heterogeneous disease with diverse etiologies and clinical trajectories. Traditionally, its diagnosis has been guided by the Dallas criteria, which focus on histopathological features. Clinically, myocarditis is categorized as acute or chronic based on the duration since symptom onset. However, recent expert consensus, particularly in Western countries, has redefined myocarditis as either acute myocarditis or chronic inflammatory cardiomyopathy, including inflammatory dilated cardiomyopathy, reflecting advancements in viral genome analysis and histopathology. In 2023, the Japanese Circulation Society proposed the concept of chronic active myocarditis, a high-risk phenotype characterized by persistent inflammation and ongoing cardiomyocyte injury. The transition from acute myocarditis to its chronic phase involves complex immune mechanisms, with sustained myocardial inflammation driving ventricular remodeling and progression to heart failure. Cardiac magnetic resonance imaging and endomyocardial biopsy remain pivotal diagnostic modalities, though their diagnostic yield varies according to disease phase. Management strategies focus on heart failure treatment, arrhythmia control, and, in select cases, immunosuppressive therapy, particularly for virus-negative inflammatory cardiomyopathy. Although antiviral therapy has shown promise, its clinical efficacy remains uncertain. Given the evolving understanding of the chronic phase of myocarditis, further research is warranted to refine the diagnostic criteria and optimize personalized therapeutic strategies. This review gives a comprehensive overview of the pathophysiology, classification, and management of chronic myocarditis, with an emphasis on emerging disease concepts and their clinical implications.</p>

DOI： 10.1253/circj.cj-25-0246

PubMed

CiNii Research

Language：English  

DOI： 10.1093/ehjimp/qyae141

PubMed

Language：English   Publisher：Nature Publishing Group  

成熟期の自然発症高血圧ラット(SHR)を用いて、腎除神経(RDN)後の血圧、心形態、交感神経活動の変化について検討した。15週齢SHRをRDN群と偽手術群に分け(各群5匹)、RDN群に対し、両側の腎動静脈周囲の神経線維束を外科的に切除し、同部に10%フェノールを塗布した。テレメトリー法により連続計測した血圧の平均値は、術後2日目から30日目(実験終了)までRDN群が偽手術群より低値であった(P<0.05)。実験終了時の心重量、心エコー評価による左室壁厚、尿中ノルエピネフリン排泄量は、RDN群が偽手術群に比べ低値を示した(P<0.05)。交感神経活動の中枢である頭側延髄腹外側野(RVLM)のチオバルビツール酸反応性物質(酸化ストレス指標)を測定したところ、RDN群で低値を示した(P<0.05)。以上より、RDNは降圧のみならず、その交感神経抑制作用から心肥大の抑制にも有効であると考えられた。

Language：English   Publisher：Hypertension Research  

This study aimed to investigate whether renal denervation (RDN) reduces blood pressure and attenuates cardiac hypertrophy with decreasing sympathetic activity in spontaneously hypertensive rats (SHRs), a model of essential hypertension, during the established phase of hypertension. We performed RDN or sham operation in 15-weeks-old SHRs. Thirty days after RDN, mean blood pressure measured by telemetry, heart weight, left ventricular wall thickness assessed by echocardiography, and urinary norepinephrine levels were significantly decreased in the RDN group compared to the Sham group. Furthermore, oxidative stress, as indicated by thiobarbituric acid reactive substances, in the rostral ventrolateral medulla, a pivotal region regulating basal sympathetic tone, was significantly decreased in the RDN group. In conclusion, RDN reduces blood pressure and attenuates cardiac hypertrophy with sympathoinhibition in the established phase of hypertension in SHRs. These findings highlight the sympathoinhibitory effect of RDN and suggest that RDN may be a potential therapy for hypertensive cardiac hypertrophy. (Figure presented.)

DOI： 10.1038/s41440-024-01596-9

Web of Science

Scopus

PubMed

Language：English   Publisher：Cjc Open  

DOI： 10.1016/j.cjco.2022.11.009

Web of Science

Scopus

PubMed

Language：Japanese  

Language：English  

Language：English  

Language：Japanese   Publisher：(公財)福田記念医療技術振興財団  

Language：Japanese   Publisher：(株)メジカルビュー社  

＜文献概要＞心筋生検の手法と目的は国や施設によって異なり,時代とともにその役割が変わってきている。ヨーロッパにおける心筋生検を用いた診断,研究体制を踏まえ,わが国の目指すべき方向性を議論する。