High prevalence of viral genomes and multiple viral infections in the myocardium of adults with "idiopathic" left ventricular dysfunction.
BACKGROUND
For a long time, enteroviruses have been considered to be the most common cause of acute viral myocarditis (MC), with possible transition from MC to dilated cardiomyopathy (DCM). Recent investigations have shown, however, that other viruses are also frequently encountered in MC patients, suggesting that persistence of various virus species may play a pathogenic role in the transition from MC to DCM. The purpose of this study was to screen endomyocardial biopsies (EMBs) from patients with "idiopathic" DCM for the presence of viral genomes by using polymerase chain reaction (PCR) to assess the frequency of cardiac viral infections that may be involved in the pathogenesis of the disease.


RESULTS
EMBs were obtained for PCR analysis from 245 consecutive patients (median left ventricular ejection fraction, 35.0%; range, 9% to 59%). PCR and reverse transcription-PCR were performed to detect the genomic sequences of enterovirus (EV), adenovirus (ADV), human cytomegalovirus (HCMV), herpes simplex virus, Epstein-Barr virus (EBV), human herpesvirus 6 (HHV-6), parvovirus B19 (PVB19), and influenza A and B viruses. Myocardial inflammation was assessed by histological and immunohistological analyses. Viral genomes could be amplified from EMBs of 165 (67.4%) of the 245 DCM patients: EV=23 (9.4%), ADV=4 (1.6%), PVB19=126 (51.4%), HHV-6=53 (21.6%), EBV=5 (2.0%), HCMV=2 (0.8%), including n=45 cases (27.3%) with multiple infections. Active or borderline myocarditis according to the Dallas classification did not exist in any case. Lymphocyte and macrophage infiltrates were not significantly different in virus-positive versus virus-negative patients.


CONCLUSIONS
Viral genomes were frequently detected in EMBs of patients with systolic left ventricular dysfunction. Our data suggest that myocardial persistence of various viruses, often presenting as multiple infections, may play a role in the pathogenesis of DCM far more frequently than suspected so far.
Kühl
Uwe
U
Charite-University Medicine Berlin, Campus Benjamin Franklin, Department of Cardiology and Pneumology, Hindenburgdamm 30, 12200 Berlin, Germany. uwe.kuehl@charite.de
Pauschinger
Matthias
M
Noutsias
Michel
M
Seeberg
Bettina
B
Bock
Thomas
T
Lassner
Dirk
D
Poller
Wolfgang
W
Kandolf
Reinhard
R
Schultheiss
Heinz-Peter
HP
D000328:Adult; D000368:Aged; D001706:Biopsy; D002311:Cardiomyopathy, Dilated / Q000209:etiology / Q000821:virology*; D005260:Female; D016679:Genome, Viral; D006321:Heart / Q000821:virology*; D006801:Humans; D007249:Inflammation; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000821:virology; D016133:Polymerase Chain Reaction; D015995:Prevalence; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000821:virology*; D014777:Virus Diseases / Q000150:complications* / Q000503:physiopathology