Inflammatory cardiomyopathy (myocarditis): which patients should be treated with anti-inflammatory therapy?

In patients presenting with congestive heart failure in the United States, approximately one-quarter have idiopathic dilated cardiomyopathy (IDC). IDC is thought to result from a number of mechanisms that injure the myocardium and lead to a common pathway of cardiac dilatation and heart failure. Known mechanisms of myocardial injury include alcohol, toxins, infections, cytotoxic chemotherapy, and metabolic abnormalities.1 Recent studies have highlighted important genetic links, suggesting that familial transmission is important in a subgroup of IDC patients. However, in most IDC patients, a cause cannot be determined.