Skip to main content
Wiley - PMC COVID-19 Collection logoLink to Wiley - PMC COVID-19 Collection
. 2013 Mar 8;38(4):295–308. doi: 10.1002/j.1552-4604.1998.tb04428.x

Innovative Drug Treatments for Viral and Autoimmune Myocarditis

Sharmila Anandasabapathy 2, William H Frishman 1,
PMCID: PMC7166703  PMID: 9590456

Abstract

Myocarditis has been shown to be a common cause of cardiomyopathy and is believed to account for 25% of all cases in human beings. Unfortunately, the disease is difficult to detect before a myopathic process ensues. Treatment of myocarditis‐induced heart failure includes the standard regimen of diuretics, digoxin, angiotensin‐converting enzyme inhibitors, and currently, β‐adrenergic blockers. Treatment of myocarditis itself is dependent on the etiology of the illness. Treatments under investigation include immunosuppressants, nonsteroidal antiinflammatory agents, immunoglobulins, immunomodulation, antiadrenergics, calcium‐channel blockers, angiotensinconverting enzyme inhibitors, nitric oxide inhibition (e.g., aminoguanidine), and antiviral agents. Despite advances in treatment, more work needs to be done in the early detection of myocarditis. Additionally, better means need to be established for distinguishing between viral and autoimmune forms of the disease, so that appropriate treatment can be instituted.

REFERENCES

  • 1. Rezkalla SH, Kloner RA: Management strategies in viral myocarditis. Am Heart J 1989;117: 706–708. [DOI] [PubMed] [Google Scholar]
  • 2. Olinde KD, O'Connell JB: Inflammatory heart disease: pathogenesis, clinical manifestations, and treatment of myocarditis. Annu Rev Med 1994;45: 481–490. [DOI] [PubMed] [Google Scholar]
  • 3. Maisch B, Herzum M, Hufnagel G, Schonian U: Immunosuppressive and immunomodulatory treatment for myocarditis. Curr Opin Cardiol 1996;11: 310–324. [DOI] [PubMed] [Google Scholar]
  • 4. Wenger NK, Abelmann WH, Roberts WC: Myocarditis In, Hurst JW, Schlant RC. eds. The Heart. Seventh edition New York: McGraw Hill, 1990;1256–1277. [Google Scholar]
  • 5. Maze SS, Adolph RJ: Myocarditis: unresolved issues in diagnosis and treatment. Clin Cardiol 1990;13: 69–79. [DOI] [PubMed] [Google Scholar]
  • 6. Pisani B, Taylor DO, Mason JW: Inflammatory myocardial diseases and cardiomyopathies. Am J Med 1997;102: 459–469. [DOI] [PubMed] [Google Scholar]
  • 7. Caforio ALP, McKenna WJ: Recognition and optimum management of myocarditis. Drugs 1996;52: 515–525. [DOI] [PubMed] [Google Scholar]
  • 8. Takada H, Kishimoto C, Hiraoka Y: Therapy with immunoglobulin suppresses myocarditis in a murine Coxsackievirus B3 model. Circulation 1995;92: 1604–1611. [DOI] [PubMed] [Google Scholar]
  • 9. Brown CA, O'Connell JB: Myocarditis and idiopathic dilated cardiomyopathy. Am J Med 1995;99: 309–314. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 10. Patel R, Frishman WH: Cardiac involvement in HIV infection. Med Clin North Am 1996;80: 1493–1507. [DOI] [PubMed] [Google Scholar]
  • 11. Schulze K, Schultheiss HP: The role of ADP‐ATP carrier in the pathogenesis of viral heart disease. Eur Heart J 1995;16(Suppl O): 64–67. [DOI] [PubMed] [Google Scholar]
  • 12. Pummerer C, Grassl G, Neu N: Cellular immune mechanisms in myosin‐induced myocarditis. Eur Heart J 1995;16(Suppl O): 71–74. [DOI] [PubMed] [Google Scholar]
  • 13. Strauer BE, Kandolf R, Mall G, Maisch B, Mertens T, Schwartzkopff B, Schultheiss HP: Myocarditis‐cardiomyopathy. Acta Cardiol 1996;4: 347–371. [PubMed] [Google Scholar]
  • 14. Khaw BA, Narula J, Sharaff AR, Nicol PD, Southern JF, Carles M: SR‐Ca2+ ATPase an autoimmunogen in experimental myocarditis. Eur Heart J 1995;16(Suppl O): 92–96. [DOI] [PubMed] [Google Scholar]
  • 15. Cooper LT, Berry GJ, Rizeq M, Schroeder JS: Giant cell myocarditis. J Heart Lung Transplant 1995;14: 394–401. [PubMed] [Google Scholar]
  • 16. Kodama M, Matsumoto Y, Fujiwara M, Masani F, Izumi T, Shibata A: A novel experimental model of giant cell myocarditis induced in rats by immunization with cardiac myosin fraction. Clin Immunol Immunopathol 1990;57: 250–262. [DOI] [PubMed] [Google Scholar]
  • 17. Lauer B, Padberg K, Schultheiss HP, Strauer BE: Autoantibodies against human ventricular myosin in sera of patients with acute and chronic myocarditis. J Am Coll Cardiol 1994;23: 146–153. [DOI] [PubMed] [Google Scholar]
  • 18. Caforio ALP: Role of autoimmunity in dilated cardiomyopathy. Br Heart J 1994;72(Suppl 6): S30–S34. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 19. Kong G, Madden B, Spyrou N, Pomerance A, Mitchell A, Yacoub M: Response of recurrent giant cell myocarditis in a transplanted heart to intensive immunosuppression. Eur Heart J 1991;12: 554–557. [DOI] [PubMed] [Google Scholar]
  • 20. Puigbo JJ: Chagas’ heart disease: clinical aspects. Cardiologia 1968;52: 91–96. [Google Scholar]
  • 21. Kiel RJ, Smith FE, Chason J, Khatib R, Reyrs MP: Coxsackievirus B3 myocarditis in C3H/Hej mice: description of an inbred model and the effect of exercise on virulence. Eur J Epidemiol 1989;5: 348–350. [DOI] [PubMed] [Google Scholar]
  • 22. Stevenson LW: Diseases of the myocardium In, Bennett JC, Plum F. eds. Cecil's Textbook of Medicine. Twentieth edition Philadelphia: WB Saunders, 1996;327–336. [Google Scholar]
  • 23. Cossart YE, Burgess YA: Fatal Coxsackievirus B myocarditis in an adult. Med J Aust 1965;1: 337–339. [DOI] [PubMed] [Google Scholar]
  • 24. Glajchen D: Myocarditis due to Coxsackievirus infection in an adult. Br Med J 1961;52: 870–871. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 25. Matsumori A, Kawai C: Immunomodulating therapy in experimental myocarditis. Springer Semin Immunopathol 1989;11: 77–88. [DOI] [PubMed] [Google Scholar]
  • 26. Matsumori A, Yamada T, Kawai C: Immunomodulating therapy in viral myocarditis: effects of tumour necrosis factor, interleukin‐2 and anti‐interleukin‐2 receptor antibody in an animal model. Eur Heart J 1991;12(Suppl D): 203–205. [DOI] [PubMed] [Google Scholar]
  • 27. Tomioka N, Kishimoto C, Matsumori A, Kawai C: Effects of prednisolone on acute viral myocarditis in mice. J Am Coll Cardiol 1986;7: 868–872. [DOI] [PubMed] [Google Scholar]
  • 28. Shanes JG, Gahli J, Billingham ME, Ferrans YJ, Fenoglio JJ, Edwards WD et al.: Inter‐observer variability in the pathological interpretation of endomyocardial biopsy results. Circulation 1987;75: 401–405. [DOI] [PubMed] [Google Scholar]
  • 29. Maisch B, Hufnagel G, Schonian U, Hengstenberg C: The European study of epidemiology and treatment of cardiac inflammatory disease (ESETCID). Eur Heart J 1995;16(Suppl O): 173–175. [DOI] [PubMed] [Google Scholar]
  • 30. Mason JW, O'Connell JB, Herskowitz A, Rose NR, McManus BM, Billingham ME, Moon TE: A clinical trial of immunosuppressive therapy for myocarditis. N Engl J Med 1995;333: 269–275. [DOI] [PubMed] [Google Scholar]
  • 31. Mason JW, Billingham ME, Ricci DR: Treatment of acute inflammatory myocarditis assisted by endomyocardial biopsy. Am J Cardiol 1980;45: 1037–1044. [DOI] [PubMed] [Google Scholar]
  • 32. Maisch B, Schonian U, Hengstenberg C, Herzum M, Hufnagel G, Bethge C et al.: Immunosuppressive treatment in autoreactive myocarditis: results from a controlled trial. Postgrad Med J 1994;70(Suppl 1): 29–34. [PubMed] [Google Scholar]
  • 33. Fenoglio JJ, Ursell PC, Kellog CF, Drusin RE, Weiss MB: Diagnosis and classification of myocarditis by endomyocardial biopsy. N Engl J Med 1983;308: 12–18. [DOI] [PubMed] [Google Scholar]
  • 34. Dec WG, Palacios IG, Fallon JT, Southern JF: Active myocarditis in the spectrum of acute dilated cardiomyopathies. N Engl J Med 1985;312: 885–890. [DOI] [PubMed] [Google Scholar]
  • 35. Anderson JL, Fowles RE, Unverferth DV, Mason JW: Immunosuppressive therapy of myocardial inflammatory disease: initial experience and further trials to define indications for therapy. Eur Heart J 1987;8(Suppl J): 263–266. 3582385 [Google Scholar]
  • 36. Kilbourne ED, Wilson CB, Perrier D: The induction of gross myocardial lesions by a Coxsackie (pleurodynia) virus and cortisone. J Clin Invest 1956;35: 362–367. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 37. Sekiguchi M, Yu Z‐X, Hasumi M, Hiroe M, Morimoto S, Nishikawa T: Histopathologic and ultrastructural observations of acute and convalescent myocarditis: a serial endomyocardial biopsy study. Heart Vessel 1985;1(Suppl 1): 143–153. [DOI] [PubMed] [Google Scholar]
  • 38. Schultheiss HP, Kuhl U, Janda I, Schanwell M, Strauer BE: Immunosuppressive therapy in myocarditis. Herz 1992;17: 112–121. [PubMed] [Google Scholar]
  • 39. Edwards WD, Holmes DR, Reeder GS: Diagnosis of active lymphocytic myocarditis by endomyocardial biopsy: quantitative criteria for light microscopy. Mayo Clin Proc 1982;57: 419–425. [PubMed] [Google Scholar]
  • 40. Maisch B, Herzum M, Hufnagel G, Bethge C, Schonian U: Immunosuppressive treatment for myocarditis and dilated cardiomyopathy. Eur Heart J 1995;16(Suppl O): 153–161. [DOI] [PubMed] [Google Scholar]
  • 41. Zhang S, Kodama M, Hanawa H, Izumi T, Shibata A, Masani F: Effects of cyclosporine, prednisolone and aspirin on rat autoimmune giant cell myocarditis. J Am Coll Cardiol 1993;21: 1254–1260. [DOI] [PubMed] [Google Scholar]
  • 42. Herzum M, Ruppert V, Kuytz B, Jomaa H, Nakamura I, Maisch B: Coxsackievirus B3 infection leads to cell death of cardiac myocytes. J Mol Cell Cardiol 1994;26: 907–913. [DOI] [PubMed] [Google Scholar]
  • 43. Cooper LT, Berry GJ, Shabetai R: Idiopathic giant cell myocarditis: natural history and treatment. N Engl J Med 1997;336: 1860–1866. [DOI] [PubMed] [Google Scholar]
  • 44. Costanzo‐Nordin MR, Reap EA, O'Connel JB, Robinson JA, Scanlon PJ: A nonsteroid anti‐inflammatory drug exacerbates Coxsackie B3 murine myocarditis. J Am Coll Cardiol 1985;6: 1078–1082. [DOI] [PubMed] [Google Scholar]
  • 45. Rezkalla SH, Khatib G, Khatib R: Coxsackievirus B3 murine myocarditis: deleterious effects of nonsteroidal anti‐inflammatory agents. J Lab Clin Med 1986;107: 393–395. [PubMed] [Google Scholar]
  • 46. Rezkalla SH, Khatib R, Khatib G, Smith F, Walsh J, Sowers J, Kloner R: Effect of indomethacin in the late phase of Coxsackievirus myocarditis in a murine model. J Lab Clin Med 1988;112: 118–121. [PubMed] [Google Scholar]
  • 47. Groothius JR, Simoes EAF, Levin MJ, Hall CB, Long CE, Rodriguez WJ et al. Prophylactic administration of respiratory syncytial virus immune globulin to high‐risk infants and young children. N Engl J Med 1993;329: 1524–1530. [DOI] [PubMed] [Google Scholar]
  • 48. Clarkson SB, Bussel JB, Kimberly RP, Valinsky JE, Nachman RL, Unkeless JC: Treatment of refractory immune thrombocytopenic purpura with an anti‐Fc receptor antibody. N Engl J Med 1986;314: 1236–1239. [DOI] [PubMed] [Google Scholar]
  • 49. Newburger JW, Takahashi M, Beiser AS, Burns JC, Bastian J, Chung KJ et al.: A single intravenous infusion of gamma globulin as compared with four infusions in the treatment of acute Kawasaki syndrome. N Engl J Med 1991;324: 1633–1639. [DOI] [PubMed] [Google Scholar]
  • 50. Drucker NA, Colan SD, Lewis AB, Beiser AS, Wessel DL, Takahashi M et al.: Gamma‐globulin treatment of acute myocarditis in the pediatric population. Circulation 1994;89: 252–257. [DOI] [PubMed] [Google Scholar]
  • 51. McNamara DM, Rosenblum WD, Janosko KM, Trost MK, Villaneuva FS, Demetris AJ et al.: Intravenous immune globulin in the therapy of myocarditis and acute cardiomyopathy. Circulation 1997;95: 2476–2478. [DOI] [PubMed] [Google Scholar]
  • 52. Sasayama S, Matsumori A, Matoba Y, Matsui S, Yamada T, Shioi T et al.: Immunomodulation: a new horizon for medical treatment of heart failure. J Cardiac Fail 1996;2(Suppl 4): S287–S294. [DOI] [PubMed] [Google Scholar]
  • 53. Shioi T, Matsumori A, Sasayama S: Persistent expression of cytokine in the chronic stage of viral myocarditis in mice. Circulation 1996;94: 2930–2937. [DOI] [PubMed] [Google Scholar]
  • 54. Matsumori A, Sasayama S: Immunomodulating agents for the management of heart failure with myocarditis and cardiomyopathy: lessons from animal experiments. Eur Heart J 1995;16(Suppl O): 140–143. [DOI] [PubMed] [Google Scholar]
  • 55. Huber SA, Polgar J, Schultheiss P, Schwimmbeck P: Augmentation of pathogenesis of Coxsackievirus B3 infections in mice by exogenous administration of interleukin‐1 and interleukin‐2. J Virol 1994;68: 195–206. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 56. Kishimoto C, Kuroki Y, Hiraoka Y, Ochiai H, Kurokawa M, Sasayama S: Cytokine and murine Coxsackievirus B3 myocarditis: interleukin‐2 suppressed myocarditis in the acute stage but enhanced the condition in the subsequent stage. Circulation 1994;89: 2836–2842. [DOI] [PubMed] [Google Scholar]
  • 57. Kishimoto C, Crumpacker CS, Abelmann WH: Prevention of murine Coxsackie B3 viral myocarditis and associated lymphoid organ atrophy with recombinant human leukocyte interferon alpha A/D. Cardiovasc Res 1988;22: 732–738. [DOI] [PubMed] [Google Scholar]
  • 58. Hiraoka Y, Kishimoto C, Takada H, Suzaki N, Shiraki K: Colony‐stimulating factors and Coxsackievirus B3 myocarditis in mice: macrophage colony‐stimulating factor suppresses acute myocarditis with increasing interferon‐alpha. Am Heart J 1995;130: 1259–1264. [DOI] [PubMed] [Google Scholar]
  • 59. Kanda T, Nagaoka H, Kaneko K, Wilson JE, McManus BM, Imai S et al.: Synergistic effects of tacrolimus and human interferon‐alpha A/D in murine viral myocarditis. J Pharm Exp Ther 1995;274: 487–493. [PubMed] [Google Scholar]
  • 60. Miric M, Vasiljevic J, Bojic M, Popvic Z, Keserovic N, Pesic M: Long‐term follow up of patients with dilated heart muscle disease treated with human leucocytic interferon alpha or thymic hormones. Heart 1996;75: 596–601. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 61. Smith SC, Allen PM: Neutralization of endogenous tumor necrosis factor ameliorates the severity of myosin‐induced myocarditis. Circ Res 1992;70: 856–863. [DOI] [PubMed] [Google Scholar]
  • 62. Sasayama S, Matsumori A: Vesnarinone: a potential cytokine inhibitor. J Cardiac Fail 1996;2: 251–258. [DOI] [PubMed] [Google Scholar]
  • 63. Rezkalla SH, Kloner RA, Khatib G, Smith FE, Khatib R: Effect of metoprolol in acute Cox sackievirus B3 murine myocarditis. J Am Coll Cardiol 1988;12: 412–414. [DOI] [PubMed] [Google Scholar]
  • 64. Djaldetti M, Van Der Lijn E, Mittelman M, Hart J: Propranolol's effect on phagocytizing ability of polymorphonuclears and monocytes (letter). Drug Intell Clin Pharm 1985;19: 583. [DOI] [PubMed] [Google Scholar]
  • 65. Hallengren B, Forsgren A, Melander A: Influence of β‐adrenoceptor blocking agents on lymphocyte function in vitro. Br J Clin Pharmacol 1982;13: 543–546. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 66. Tominaga M, Matsumori A, Okada I, Yamada T, Kawai C: Beta blocker treatment of dilated cardiomyopathy: beneficial effect of carteolol in mice. Circulation 1991;83: 2021–2028. [DOI] [PubMed] [Google Scholar]
  • 67. Awan NA, Miller RR, Mason DT: Comparison of effects of nitroprusside and prazosin on left ventricular function and the peripheral circulation in chronic refractory congestive heart failure. Circulation 1978;57: 152–159. [DOI] [PubMed] [Google Scholar]
  • 68. Cohn JN, Franciosa JA: Vasodilator therapy of cardiac failure. N Engl J Med 1977;297: 27–31, 254–258. [DOI] [PubMed] [Google Scholar]
  • 69. Yamada T, Matsumori A, Okada I, Tominaga M, Kawai C: The effect of alpha‐1 blocker bunazosin on a murine model of congestive heart failure induced by viral myocarditis. Jpn Circulation J 1992;56: 1138–1145. [DOI] [PubMed] [Google Scholar]
  • 70. Factor SM, Minase T, Cho S, Dominitz R, Sonnenblick EH: Microvascular spasm in the cardiomyopathic Syrian hamster: a preventable cause of focal myocardial necrosis. Circulation 1982;66: 342–354. [DOI] [PubMed] [Google Scholar]
  • 71. Morris SA, Weiss LM, Factor SM, Bilizekian JP, Tanowitz H, Witiner M: Verapamil ameliorates clinical, pathologic and biochemical manifestations of experimental chagasic cardiomyopathy in mice. J Am Coll Cardiol 1989;14: 782–789. [DOI] [PubMed] [Google Scholar]
  • 72. Dong R, Liu P, Wee L, Butany J, Sole MJ: Verapamil ameliorates the clinical and pathological course of murine myocarditis. J Clin Invest 1992;90: 2022–2030. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 73. Goldstein RE, Boccuzzi SJ, Cruess D, Nattel S: Diltiazem increases late‐onset congestive heart failure in postinfarction patients with early reduction in ejection fraction. Circulation 1991;83: 52–60. [DOI] [PubMed] [Google Scholar]
  • 74. Ferlinz J, Gallo CT: Responses of patients in heart failure to long‐term oral verapamail administration (abstract). Circulation 1984;70(Suppl II): II‐305. [Google Scholar]
  • 75. Packer M, O'Connor CM, Ghali JK, Pressler ML, Carson PE, Belkin RN et al. Effect of amlodipine on morbidity and mortality in severe chronic heart failure. N Engl J Med 1996;335: 1107–1114. [DOI] [PubMed] [Google Scholar]
  • 76. Wang WZ, Matsumori A, Yamada T, Shioi T, Okada I, Matsui S et al.: Beneficial effects of amlodipine in a murine model of congestive heart failure induced by viral myocarditis. Circulation 1997;95: 245–251. [DOI] [PubMed] [Google Scholar]
  • 77. Szabo C, Thiemermann C, Vane JR: Dihydropyridine antagonists and agonists of calcium channels inhibit the induction of nitric oxide synthase by endotoxin in cultured macrophages. Biochem Biophys Res Commun 1993;196: 825–830. [DOI] [PubMed] [Google Scholar]
  • 78. Hirono S, Islan O, Nakazawa M, Yoshida Y, Kodama M, Shibata A, Izumi T, Imai S: Expression of rat inducible nitric oxide synthase in rat experimental autoimmune myocarditis with special reference to changes in cardiac hemodynamics. Circ Res 1997;80: 11–20. [DOI] [PubMed] [Google Scholar]
  • 79. Stein B, Frank P, Schmitz W, Scholz H, Thoenes M: Endotoxin and cytokines induce direct cardiodepressive effects in mammalian cardiomyocytes via induction of nitric oxide synthase. Mol Cell Cardiol 1996;28: 1631–1639. [DOI] [PubMed] [Google Scholar]
  • 80. Ishiyama S, Hiroe M, Nishikawa T, Abe S, Shimojo T, Ito H et al.: Nitric oxide contributes to the progression of myocardial damage in experimental autoimmune myocarditis in rats. Circulation 1997;95: 489–496. [DOI] [PubMed] [Google Scholar]
  • 81. Rezkalla SH, Kloner RA, Khatib G, Khatib R: Beneficial effects of captopril in acute Coxsackievirus B3 murine myocarditis. Circulation 1990;81: 1039–1046. [DOI] [PubMed] [Google Scholar]
  • 82. Suzuki H, Matsumori A: Myocardial injury due to viral myocarditis improved by captopril in mice (abstract). Circulation 1990;82(Suppl III): III–674. [Google Scholar]
  • 83. Suzuki H, Matsumori A, Kawai CH: Effects of angiotensin converting enzyme inhibitors on myocardial injury and congestive heart failure due to myocarditis in mice: comparison with captopril and enalapril (abstract). Circulation 1991;84(Suppl III): III‐634. [Google Scholar]
  • 84. Rezkalla SH, Raikar S, Kloner R: Treatment of viral myocarditis with focus on captopril. Am J Cardiol 1996;77: 634–637. [DOI] [PubMed] [Google Scholar]
  • 85. Tanaka A, Matsumori A, Wang W, Sasayama S: An angiotensin II receptor antagonist reduces myocardial damage in an animal model of myocarditis. Circulation 1994;90: 2051–2055. [DOI] [PubMed] [Google Scholar]
  • 86. Matsumori A, Wang H, Ablemann WH, Crumpacker CS: Treatment of viral myocarditis with ribavirin in an animal preparation. Circulation 1985;71: 834–839. [DOI] [PubMed] [Google Scholar]
  • 87. Kishimoto C, Crumpacker CS, Abelmann WH: Ribavirin treatment of murine Coxsackievirus B3 myocarditis with analyses of lymphocyte subsets. J Am Coll Cardiol 1988;12: 1334–1341. [DOI] [PubMed] [Google Scholar]
  • 88. Fohlman J, Pauksen K, Hyypia T, Eggertsen G, Ehrnst A, Ilback NG, Friman G: Antiviral treatment with WIN 54954 reduces mortality in murine Coxsackievirus B3 myocarditis. Circulation 1996;94: 2254–2259. [DOI] [PubMed] [Google Scholar]
  • 89. O'Connell JB, Dec WG, Goldenberg IF, Starling RC, Mudge GH, Augustine SM et al.: Results of heart transplantation for active lymphocytic myocarditis. J Heart Transplant 1990;9: 351–356. [PubMed] [Google Scholar]
  • 90. O'Connell JB, Breen TJ, Hosenpud JD: Heart transplantation in dilated heart muscle disease and myocarditis. Eur Heart J 1995;16(Suppl O): 137–139. [DOI] [PubMed] [Google Scholar]
  • 91. DeCarvalho VB, Sousa EFL, Vila JHA, daSilva JP, Caiado MR, Araujo SR et al.: Heart transplantation in Chagas’ disease. Circulation 1996;94: 1815–1817. [DOI] [PubMed] [Google Scholar]
  • 92. Sole MJ, Liu P: Viral myocarditis: a paradigm for understanding the pathogenesis and treatment of dilated cardiomyopathy. J Am Coll Cardiol 1993;22(Suppl A): 99A–105A. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Clinical Pharmacology are provided here courtesy of Wiley

RESOURCES