**Part 3**

**Recent Advances in Myocarditis** 

320 Myocarditis

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myocarditis. *J Clin Immunol*, Vol. 30, No. 2, (Mar 2010), pp. 226-234.

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120.

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TAK-491, a new angiotensin receptor blocker, and pioglitazone, in reducing myocardial infarct size. *Cardiovasc Drugs Ther*, Vol. 24, No. 2, (Apr 2010), pp. 107-

Th17 cells facilitate the humoral immune response in patients with acute viral

**16** 

*USA* 

**Biomarkers of Heart Failure in Myocarditis** 

There are many reviews that discuss the role of biomarkers in cardiovascular disease (CVD) and heart failure (Braunwald, 2008; Chen et al., 2010; Hochholzer et al., 2010), but little information exists regarding the presence and usefulness of biomarkers for heart failure in myocarditis and dilated cardiomyopathy (DCM) patients. Heart failure (HF) is the end consequence of many CVDs including atherosclerosis, myocardial infarction, myocarditis and DCM. CVD is the leading cause of morbidity and mortality in Western nations (Roger et al., 2011), and a growing concern worldwide (Gaddam et al., 2011). As treatments for CVD prolong survival, the prevalence of chronic HF has increased. It is now estimated that 5.8 million people in the United States live with HF and over 23 million worldwide (Bui et al., 2011). Approximately 550,000 new cases of HF are diagnosed each year, with a lifetime risk for developing disease of one in five (Chen et al., 2010; Krumholz et al., 1997). Hospitalizations for HF have also increased dramatically in the United States from 402,000 in 1979 to 2.4 million in 2007 with the cost of treating HF patients estimated at \$39 billion annually (Bui et al., 2011; Chen et al., 2010; Roger et al., 2011). Biomarkers have become an increasingly important clinical tool for assessing CVD and progression to HF. Biomarkers are used in early detection of sub-clinical disease, diagnosis, risk stratification, monitoring disease state, and to determine therapies (Hochholzer et al., 2010). Many biomarkers are also

In spite of advances in diagnosis and treatment, HF remains a growing medical problem associated with major hospitalization, mortality and poor prognosis. Heart failure is characterized by significantly reduced cardiac output resulting in an inability to meet the metabolic needs of the body. Most cases of HF are caused by systolic dysfunction, or reduced myocardial contractile function, as occurs during ischemic injury, pressure or volume overload and DCM. However, HF can also occur because of an inability to relax, expand or fill the ventricle resulting in diastolic dysfunction as observed during myocardial fibrosis and constrictive pericarditis (Afanasyeva et al., 2004; Kumar et al., 2005). The prevalence of HF is higher in men than women and sex is a major risk factor along with age, hypertension, left ventricular (LV) hypertrophy, valvular heart disease, obesity and diabetes (Bui et al., 2011; Roger et al., 2011) (Table 1). The New York Heart Association (NYHA) has

risk factors directly involved in the pathogenesis of disease.

**1. Introduction** 

**2. Heart failure** 

DeLisa Fairweather, Eric D. Abston and Michael J. Coronado

**and Dilated Cardiomyopathy** 

*Johns Hopkins University Bloomberg School of Public Health* 
