title: Prevalence and prognostic implications of active cytomegalovirus infection in patients with acute heart failure.
abstract: AHF (acute heart failure) causes significant morbidity and mortality. Recent studies have postulated that the expression of inflammatory mediators, such as cytokines and chemokines, plays an important role in the development and progression of heart failure. A pro-inflammatory state has been postulated as a key factor in triggering CMV (cytomegalovirus) reactivation. Therefore we sought to determine the prevalence of active CMV infection in immunocompetent patients admitted for AHF and to quantify the association with the risk of the combined end point of death or AHF readmission. A total of 132 consecutive patients admitted for AHF were enrolled in the present study. Plasma CMV DNAaemia was assessed by qRT-PCR (quantitative real-time PCR), and cytokine measurements in plasma were performed by ELISA. Clinical data were evaluated by personnel blinded to CMV results. The independent association between active CMV infection and the end point was determined by Cox regression analysis. During a median follow-up of 120 [IQR (interquartile range), 60-240] days, 23 (17.4%) deaths, 34 (24.2%) readmissions for AHF and 45 (34.1%) deaths/readmissions for AHF were identified. Plasma CMV DNAaemia occurred in 11 (8.3%) patients, albeit at a low level (<100 copies/ml). The cumulative rate of the composite end point was higher in patients with CMV DNAaemia (81.8 compared with 29.8%; P<0.001). After adjusting for established risk factors, the occurrence of CMV DNAaemia was strongly associated with the clinical end point [hazard ratio = 4.39 (95% confidence interval, 2.02-9.52); P<0.001]. In conclusion, active CMV infection occurs, although uncommonly, in patients with AHF, and may be a marker of disease severity.
authors.affiliation: Cardiology Service, Hospital Clínico Universitario, INCLIVA, Blasco Ibañez 17, Valencia, Spain. yulnunez@gmail.com
authors.forename: Julio
authors.initials: J
authors.lastname: Núñez
authors.forename: Marifina
authors.initials: M
authors.lastname: Chilet
authors.forename: Juan
authors.initials: J
authors.lastname: Sanchis
authors.forename: Vicent
authors.initials: V
authors.lastname: Bodí
authors.forename: Eduardo
authors.initials: E
authors.lastname: Núñez
authors.forename: Gema
authors.initials: G
authors.lastname: Miñana
authors.forename: Nuria
authors.initials: N
authors.lastname: Tormo
authors.forename: Maria A
authors.initials: MA
authors.lastname: Clari
authors.forename: Mauricio
authors.initials: M
authors.lastname: Pellicer
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Chorro
authors.forename: Angel
authors.initials: A
authors.lastname: Llàcer
authors.forename: David
authors.initials: D
authors.lastname: Navarro
mesh_terms: D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D016207:Cytokines / Q000097:blood; D003587:Cytomegalovirus / Q000235:genetics / Q000302:isolation & purification / Q000502:physiology*; D003586:Cytomegalovirus Infections / Q000097:blood / Q000150:complications*; D004279:DNA, Viral / Q000097:blood; D004812:Epidemiologic Methods; D005260:Female; D006333:Heart Failure / Q000097:blood / Q000150:complications*; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D011379:Prognosis; D014775:Virus Activation
chemical_list: D016207:Cytokines; D004279:DNA, Viral; D018836:Inflammation Mediators