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Eur J Heart Fail. 2018 Mar;20(3):445-459. doi: 10.1002/ejhf.1138. Epub 2018 Jan 15.

The innate immune system in chronic cardiomyopathy: a European Society of Cardiology (ESC) scientific statement from the Working Group on Myocardial Function of the ESC.

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Department of Internal Medicine I, University Hospital Würzburg, Germany; Department of Internal Medicine III, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany.
Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, Portugal.
Pole of Pharmacology and Therapeutics, Institut de Recherche Experimentale et Clinique (IREC), and Clinique Universitaire Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
Department of Cardiology and Angiology, Medizinische Hochschule, Hannover, Germany.
Prof. Emer, University of Antwerp, Antwerp, Belgium.
Department of Medicine and Surgery, University of Salerno, Baronissi, Italy.
School of Medicine and Dentistry, University of Aberdeen, Aberdeen, Scotland.
Department of Cardiology, CARIM School for Cardiovascular Diseases Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
International Centre for Genetic Engineering and Biotechnology (ICGEB) and Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
Department of Cardiovascular Physiology, Ruhr University Bochum, Bochum, Germany.
Molecular Cardiology, Department of Cardiology and Angiology, Medizinische Hochschule, Hannover, Germany.
Department of Molecular Biotechnology and Health Sciences, University of Torino, Torino, Italy.
Department of Physiology and Cardiothoracic Surgery and Cardiovascular Research Centre, Faculty of Medicine, University of Porto, Porto, Portugal.
The James Black Centre and King's British Heart Foundation Centre, King's College, University of London, London, UK.
Institute of Molecular and Translational Therapeutic Strategies (IMTTS), IFB-Tx, and REBIRTH Excellence Cluster, Hannover Medical School, Hannover, Germany.
Department of Translational Medical Sciences, Federico II University, Naples, Italy.
Department of Physiology, VU University Medical Center, Amsterdam Cardiovascular Sciences Institute, Amsterdam, The Netherlands.
Netherlands Heart Institute, Utrecht, The Netherlands.
Center for Basic and Clinical Immunology Research (CISI), Federico II University, Naples, Italy.
Department of Cardiovascular Sciences, Leuven University, Leuven, Belgium.


Activation of the immune system in heart failure (HF) has been recognized for over 20 years. Initially, experimental studies demonstrated a maladaptive role of the immune system. However, several phase III trials failed to show beneficial effects in HF with therapies directed against an immune activation. Preclinical studies today describe positive and negative effects of immune activation in HF. These different effects depend on timing and aetiology of HF. Therefore, herein we give a detailed review on immune mechanisms and their importance for the development of HF with a special focus on commonalities and differences between different forms of cardiomyopathies. The role of the immune system in ischaemic, hypertensive, diabetic, toxic, viral, genetic, peripartum, and autoimmune cardiomyopathy is discussed in depth. Overall, initial damage to the heart leads to disease specific activation of the immune system whereas in the chronic phase of HF overlapping mechanisms occur in different aetiologies.


Autoimmune cardiomyopathy; Diabetic cardiomyopathy; Genetic cardiomyopathy; Hypertensive cardiomyopathy; Immune system; Ischaemic cardiomyopathy; Macrophage; Peripartum cardiomyopathy; T-cell; Toxic cardiomyopathy; Viral cardiomyopathy

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