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In contrast to ischemic heart disease, the disease process begins in the subepicardium and progresses toward the endocardium.
Inflammatory infiltrates appear in the subepicardium at day 3 post-infection, followed by extensive infiltration across the interstitium and perivascular areas deep into the myocardium, accompanied by extracellular matrix destruction at days 6 and 9, though resolution is evident at day 12 (Fig.
Antzelevitch, "A subpopulation of cells with unique electrophysiological properties in the deep subepicardium of the canine ventricle.