The recent rapid advances in our knowledge of immunological and virological mechanisms involved in the pathogenesis of viral heart disease makes it difficult for everybody working in this field to keep up with the latest developments. How ever, much of what we know is still circumstantial and only vaguely substained. Interdisciplinary understanding and cooperation thus seems necessary to get a better insight into the mechanisms by which viruses may initiate immunological organ-specific tissue injury and disease! This volume evolved out of an international symposium by the same title held on May 25. -28. , 1988 in Tegernsee, near Munich, of which a wide spectrum ofim munological, virological, diagnostical and clinical problems was covered. Both review articles and new experimental and clinical data are included in this volume to give the reader an up-to-date information about current concepts and future aspects. Chapter I serves as an excellent introduction to the epidemiology and natural history of dilated cardiomyopathy / viral heart disease. Although a definite viral etiology in myocarditis and dilated cardiomyopathy is often difficult to establish, epidemiological and serological data incriminate a viral etiology underlying many cases of "dilated cardiomyopathy". Chapters II and III describe the current think ing on virological and immunological mechanisms involved in the pathogenesis of viral heart disease. Among others virus topism, virus persistance, possible mecha nisms and genetic basis of post-infection autoimmunity, and the virus-interaction with the immune system are discussed.

I. Epidemiology and Natural History

The Etiology, Pathogenesis and Pathophysiology of Dilated Cardiomyopathies
Virological, Immunological and Clinical Features of Myocarditis and Dilated Cardiomyopathy
Epidemiology and Pathogenicity of Coxsackieviruses
Natural History of Acute Viral or Idiopathic Myocarditis: A Clinical and Endomycardial Biopsy Follow-up
Myocarditis in Patients with Dilated Cardiomyopathy- Correlation with Clinical, Hemodynamic and Biochemical Findings
Coxsackievirus Cardiomyopathy in Animal Models, Including the Augmenting Effect of Exercise During the Acute Phase
II. Concepts in Viral Pathogenesis
Replication, Molecular Biology, and Pathogenesis of Coxsackieviruses
A Murine Model for Coxsackievirus B3-Induced Acute Myocardial Necrosis for Study of Cellular Receptors as Determinants of Viral Tropism
Induction of Soluble Mediators During Coxsackievirus B3 Replication In Vitro and In Vivo
Persistence of Echovirus Type 6 in Cultured Cells
Detection and Typing of Enteroviruses by Nucleic Acid Probes and Monoclonal Antibodies
Generation of Enterovirus Group-Specific Antisera Using Bacterially Synthesized Coxsackievirus B3 Proteins
III. Virus and Immunity
Myocarditis: A Post-infectious Autoimmune Disease
Viral Myocarditis: Immunogenetic and Autoimmune Aspects
Is Coxsackievirus B3-Induced Myocarditis in A/J Mice Mediated by an Autoimmune Response to Cardiac Myosin?
Virus-Induced Autoimmunity: Cross-Reactivity of Antiviral Antibodies with Self-Components
Immunopathogenic Mechanisms in Experimental Myocarditis: Evidence for Autoimmunity to the Virus Receptor and Antigenic Mimicry Between the Virus and Cardiocyte
Coxsackie B3 Myocarditis: Genetic Aspects of Different Immunopathogenetic Mechanisms in BALB/c and DBA/2Mice. Antigenic Specificity of Heart-Reactive Antibodies in DBA/2 Mice
Interactions of Group B Coxsackieviruses with Immunocytes
Early Cellular Infiltrates in Coxsackievirus B3 Murine Myocarditis
IV. Characterization of Autoimmunological Mechanisms
Beta-Adrenoceptor Autoantibodies in Idiopathic Dilated Cardiomyopathy
Antibodies Against the ADP/ATP Carrier Crossreact with the Ca-Channel - Functional and Biochemical Data
Antibodies and Autoantibodies against ADP/ATP Carrier Enhance Calcium Current in Isolated Ventricular Myocytes
Antibodies Against the ADP/ATP Carrier Alter Myocardial Function by Disturbing Cellular Energy Metabolism
The Importance of Humoral and Cellular Immunological Parameters for the Pathogenesis of Viral Myocarditis
Characterization of T-Lymphocytes Cultured from Human Endomyocardial Biopsies
V. Diagnostic Criteria
The Role of Biopsy in the Diagnosis and Follow-up of Myocarditis. A Critical Review
Impaired Myocardial Ultra-Structure and Cytoskeleton in Cardiomyopathic Human Myocardium
Immunofluorescence Microscopy in the Diagnosis and Follow-up of Patients Suspected of Having Inflammatory Heart Disease
of Major Histocompatibility (MHC) Antigens on Myocardial Cells in Patients with Active Myocarditis and Idiopathic Cardiomyopathy
Evalution of Immunohistological Data for the Diagnosis of Myocarditis
Enteroviral Heart Disease: Diagnosis by In Situ Hybridization
Persistence of Enterovirus RNA in Dilated Cardiomyopathy: A Progression from Myocarditis
Diagnosis of Acute Myocarditis with Radiolabeled Monoclonal Antimyosin Antibody: Immunoscintigraphic Evaluation
VI. Immuno-Modulating Therapy: Experimental and Clinical Approaches
Animal Models for Therapeutic Trials of Viral Myocarditis: Effect of Ribavirin andAlpha Interferon on Coxsackievirus B3 and Encephalomyocarditis Virus Myocarditis
Antiviral Activity of Human Fibroblast Interferon in Coxsackievirus B3-Infected Cultured Human Heart Cells
Immunosuppressive Therapy in Myocarditis: Acute Viral Versus Chronic Idiopathic Myocarditis
Immunosuppressive Treatment in Myocarditis
The Role of Cardiac Transplantation in Patients with Active Myocarditis
Clinical and Experimental Aspects of Treatment for Viral Myocarditis
VII. New Aspects of Clinical Management
Alterations of Receptors and of Agonist Effectiveness in Myocardial Failure
Positive Inotropic Drugs in the Treatment of Chronic Congestive Heart Failure: A Critical Up-date
Effect of ACE-Inhibitors on Myocardial Perfusion
Experimental Evidence for Cardioprotection Afforded by Ramipril, an Inhibitor of Angiotensin Converting Enzyme
Energetic Consequences of Pharmacological Therapy in Patients with Myocardial Failure
The Effect of ACE Inhibitors on Energy Metabolism in Chronic Heart Failure - Enzymatic Studies of Myocardial Biopsies.