Heart Muscle Antibodies in Rheumatic Fever and Other Diseases*

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Abstract
Serum factors reactive with human heart muscle were investigated by the indirect immunofluorescent technique in 624 subjects. Two main staining patterns were observed: sarcolemmal-subsarcolemmal and diffuse; an intermyofibrillar pattern was also seen. In acute rheumatic fever, 41.5% of the patients showed the sarcolemmal-subsarcolemmal pattern, the latter at times accompanied by intermyofibrillar staining. In the presence of carditis, this percentage increased to 63.4%. Only 16.4% of a group of inactive rheumatic subjects gave positive reactions. 27% of 22 patients with myocardial infarction showed the diffuse type of immunofluorescent reaction; only 1 patient gave the sarcolemmal-subsarcolemmal pattern. The diffuse staining pattern was also occasionally seen in patients with acute glomerulonephritis and rheumatoid arthritis. Other groups, including 66 normal subjects, showed a low incidence of positive reactions. There was a striking increase in incidence of positive reactions after cardiac surgery for rheumatic heart disease as compared with congenital heart disease. There appeared to be no relationship between the incidence of positive reactions and antistreptolysin-0 titer. The evidence indicates that the serum factors are antibody in nature.