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

Stefan Frantz, Ines Falcao-Pires, Jean Luc Balligand, Johann Bauersachs, Dirk Brutsaert, Michele Ciccarelli, Dana Dawson, Leon J. de Windt, Mauro Giacca, Nazha Hamdani, Denise Hilfiker-Kleiner, Emilio Hirsch, Adelino Leite-Moreira, Manuel Mayr, Thomas Thum, Carlo G. Tocchetti, Jolanda van der Velden, Gilda Varricchi, Stephane Heymans

Research output: Contribution to journalReview articleAcademicpeer-review

115 Citations (Scopus)


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.

Original languageEnglish
Pages (from-to)445-459
Number of pages15
JournalEuropean journal of heart failure
Issue number3
Publication statusPublished - 1 Mar 2018


  • 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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