title: Serological and molecular evidence of enterovirus infection in patients with end-stage dilated cardiomyopathy.
abstract: OBJECTIVE
  To study the relative diagnostic value of enterovirus-specific molecular biological and serological assays in patients with end-stage dilated cardiomyopathy, and to investigate the possible role of other cardiotropic viruses in dilated cardiomyopathy.
  
  
  METHODS
  Analysis of recipient myocardial tissue and serum from patients with dilated cardiomyopathy and controls undergoing cardiac transplantation for end-stage cardiac disease.
  
  
  METHODS
  University virology department and transplantation unit.
  
  
  METHODS
  Reverse transcriptase-polymerase chain reaction and nucleotide sequence analysis of myocardial RNA and DNA; enterovirus-specific in situ hybridization; enterovirus-specific immunoglobulin M detection.
  
  
  RESULTS
  Enterovirus RNA was detected in myocardial tissue from only a small proportion of (five of 75) hearts. However, although enterovirus-specific immunoglobulin M responses were detected in 22 (28%) of 39 controls patients, a significantly higher prevalence was observed among patients with dilated cardiomyopathy (22 (56%) of 39 patients; P < 0.005). All enteroviruses detected in myocardium showed greatest nucleotide sequence homology with coxsackievirus type B3. Detection of enterovirus RNA in myocardium by the polymerase chain reaction and by in situ hybridisation gave comparable results. Other potentially cardiotropic virus genomes, including human cytomegalovirus, influenzaviruses, and coronaviruses were not detected in myocardium.
  
  
  CONCLUSIONS
  This study found that enterovirus-specific immunoglobulin M responses provided the strongest evidence of enterovirus involvement in patients with end-stage dilated cardiomyopathy. However, the high background prevalence of these responses limits their diagnostic value. The finding that enteroviruses detected in myocardium were coxsackievirus type B3 accords with recent findings in patients with acute myocarditis, and indicates that this serotype is the major cardiotropic human enterovirus.
authors.affiliation: Department of Virology, United Medical and Dental Schools of Guy's and St Thomas' Hospitals, London.
authors.forename: P
authors.initials: P
authors.lastname: Muir
authors.forename: F
authors.initials: F
authors.lastname: Nicholson
authors.forename: S J
authors.initials: SJ
authors.lastname: Illavia
authors.forename: T S
authors.initials: TS
authors.lastname: McNeil
authors.forename: J F
authors.initials: JF
authors.lastname: Ajetunmobi
authors.forename: H
authors.initials: H
authors.lastname: Dunn
authors.forename: W G
authors.initials: WG
authors.lastname: Starkey
authors.forename: K N
authors.initials: KN
authors.lastname: Reetoo
authors.forename: N R
authors.initials: NR
authors.lastname: Cary
authors.forename: J
authors.initials: J
authors.lastname: Parameshwar
authors.forename: J E
authors.initials: JE
authors.lastname: Banatvala
mesh_terms: D000914:Antibodies, Viral / Q000097:blood; D001483:Base Sequence; D002311:Cardiomyopathy, Dilated / Q000821:virology*; D017931:DNA Primers / Q000235:genetics; D004770:Enterovirus / Q000235:genetics* / Q000276:immunology*; D029822:Enterovirus B, Human / Q000235:genetics; D004769:Enterovirus Infections / Q000175:diagnosis*; D006321:Heart / Q000821:virology*; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D017403:In Situ Hybridization; D008969:Molecular Sequence Data; D012367:RNA, Viral / Q000032:analysis; D016415:Sequence Alignment
chemical_list: D000914:Antibodies, Viral; D017931:DNA Primers; D007075:Immunoglobulin M; D012367:RNA, Viral