Parvovirus B19 infection mimicking acute myocardial infarction.
BACKGROUND
Enteroviruses (EVs) and adenoviruses (ADVs) have been considered common causes of myocarditis and dilated cardiomyopathy. In the present study, we report on the association of parvovirus B19 (PVB19) genomes in the clinical setting of acute myocarditis.


RESULTS
This study included 24 consecutive patients admitted to our hospital within 24 hours after onset of chest pain. Acute myocardial infarction had been excluded in all patients by coronary angiography. Endomyocardial biopsies were analyzed by nested polymerase chain reaction/reverse transcriptase-polymerase chain reaction for EV, ADV, PVB19, human cytomegalovirus, Epstein-Barr virus, Chlamydia pneumoniae, influenza virus A and B, and Borrelia burgdorferi genomes, respectively, followed by direct sequencing of the amplification products. All patients presented with acute onset of angina pectoris and ST-segment elevations or T-wave inversion mimicking acute myocardial infarction. Mean baseline peak creatinine kinase and creatine kinase-isoenzyme fraction were 342+/-241 U/L and 32+/-20 U/L, respectively. Mean troponin T was increased to 7.5+/-15.0 ng/mL and C-reactive protein to 91+/-98 mg/mL. Eighteen patients had global or regional wall motion abnormalities (ejection fraction 62.5+/-15.5%). Histological analysis excluded the presence of active or borderline myocarditis in all but one patient. PVB19, EV, and ADV genomes were detected in the myocardium of 12, 3, and 2 patients, respectively (71%). Follow-up biopsies of virus-positive patients (11 of 17) demonstrated persistence of PVB19 genomes in 6 of 6 patients, EV genomes in 2 of 3 patients, and ADV genomes in 1 of 2 patients, respectively.


CONCLUSIONS
Virus genomes can be demonstrated in 71% of patients with normal coronary anatomy, clinically mimicking acute myocardial infarction. In addition to EVs and ADVs, PVB19 was the most frequent pathogen.
Kühl
Uwe
U
Medical Clinic II, Department of Cardiology, University Hospital Benjamin Franklin, Berlin, Germany. dcmkuehl@zedat.fu-berlin.de
Pauschinger
Matthias
M
Bock
Thomas
T
Klingel
Karin
K
Schwimmbeck
C Peter Lothar
CP
Seeberg
Bettina
B
Krautwurm
Lars
L
Poller
Wolfgang
W
Schultheiss
Heinz-Peter
HP
Kandolf
Reinhard
R
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000787:Angina Pectoris / Q000209:etiology; D001706:Biopsy; D002637:Chest Pain / Q000209:etiology; D017023:Coronary Angiography; D004279:DNA, Viral / Q000032:analysis / Q000235:genetics; D003937:Diagnosis, Differential; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000821:virology; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis* / Q000821:virology; D009205:Myocarditis / Q000150:complications / Q000175:diagnosis* / Q000821:virology; D009206:Myocardium / Q000473:pathology; D010322:Parvoviridae Infections / Q000150:complications / Q000175:diagnosis* / Q000821:virology; D016732:Parvovirus B19, Human / Q000235:genetics / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction; D012008:Recurrence; D014780:Viruses / Q000235:genetics / Q000302:isolation & purification*
D004279:DNA, Viral