Intravenous immunoglobulin therapy for patients with idiopathic cardiomyopathy and endomyocardial biopsy-proven high PVB19 viral load.
BACKGROUND
Parvovirus B19 (PVB19) persistence in the heart has been associated with progressive cardiac dysfunction and evolution to dilated cardiomyopathy. In the present study, we investigated whether immunomodulation with intravenous immunoglobulin (IVIg) in addition to conventional heart failure therapy is safe and achieves virus reduction. Such therapy might improve cardiac function in patients with chronic dilated cardiomyopathy (DCM) and a significant PVB19 viral load in the heart.


METHODS
PVB19 viral load was studied in 25 post-mortem cardiac samples of patients with a normal heart. Then, 17 consecutive patients (mean age 53 +/-3 years) with DCM and symptomatic heart failure for >1 year with a PVB19 viral load in endomyocardial biopsies of >250 copies/microg DNA were treated with a high dose of IVIg (2 g/kg).


RESULTS
The post-mortem cardiac samples revealed a PVB19 presence in 80% with a mean load of 131 +/-40 copies/microg DNA. In the treated patients, IVIg resulted in a significant decrease of PVB19 viral load from 1,420 +/-216 to 619 +/-200 copies/microg DNA (P=0.004) and significantly improved the ejection fraction from 33 +/-3% 6 months before treatment and 34 +/-3% at baseline to 41 +/-3% 6 months (P=0.001) after IVIg therapy. The New York Heart Association classification significantly improved from 2.5 +/-0.1 at baseline to 2.1 +/-0.1 at follow-up (P=0.004). No therapy-related complications were noted.


CONCLUSIONS
The present pilot study demonstrates that IVIg significantly reduces viral load and improves cardiac function in patients with DCM related to increased PVB19 viral load in the heart.
Dennert
Robert
R
Department of Cardiology, CARIM, University Hospital Maastricht, Maastricht, the Netherlands.
Velthuis
Sebastiaan
S
Schalla
Simon
S
Eurlings
Luc
L
van Suylen
Robert-Jan
RJ
van Paassen
Pieter
P
Tervaert
Jan William Cohen
JW
Wolffs
Petra
P
Goossens
Valàre J
VJ
Bruggeman
Catrien
C
Waltenberger
Johannes
J
Crijns
Harry J
HJ
Heymans
Stephane
S
D000328:Adult; D000368:Aged; D001706:Biopsy; D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000209:etiology / Q000628:therapy* / Q000821:virology; D004279:DNA, Viral / Q000032:analysis / Q000302:isolation & purification; D005260:Female; D006321:Heart / Q000503:physiopathology / Q000821:virology; D006333:Heart Failure / Q000209:etiology / Q000628:therapy; D006801:Humans; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use*; D007155:Immunologic Factors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000188:drug therapy / Q000209:etiology / Q000628:therapy / Q000821:virology; D009206:Myocardium / Q000473:pathology; D010322:Parvoviridae Infections / Q000150:complications / Q000628:therapy* / Q000821:virology; D016732:Parvovirus B19, Human / Q000235:genetics / Q000302:isolation & purification / Q000502:physiology*; D010865:Pilot Projects; D017422:Sequence Analysis, DNA; D016896:Treatment Outcome; D019562:Viral Load
D004279:DNA, Viral; D016756:Immunoglobulins, Intravenous; D007155:Immunologic Factors