title: Patchy myocardial pattern of virus sequence persistence in heart transplant recipients--possible role of sampling error in the etiology.
abstract: BACKGROUND
  The pathway from viral myocarditis to end-stage heart failure is commonly accepted, but diagnosis of virus-mediated myocardial injury remains challenging. Virus persistency in the myocardium may accelerate ventricular failure; thus, a precise diagnosis of virus persistency may prevent the development of end-stage heart failure.
  
  
  METHODS
  We performed a systematic investigation on the sampling error of viral diagnostics in heart transplant recipients: Transmural samples from 5 regions of the explanted hearts from recipients during heart transplantation were amplified using entero-, adeno-, and herpesvirus sequences and histologic examinations performed.
  
  
  RESULTS
  We examined 175 myocardial samples from dilated cardiomyopathy and 100 samples from 20 forensic medicine patients. Seven patients were positive for the examined viruses: 10 positive regions for adenovirus, and 1 positive region for herpes virus DNA, but none for enterovirus. A focal myocardial pattern was detected for adenovirus.
  
  
  CONCLUSIONS
  Our results with the patchy myocardial viral persistence may explain possible false-negative results related to virus-mediated etiology among end-stage dilated cardiomyopathy patients. Therefore, repeated endomyocardal biopsies, and multiple cardiac samples are recommended to be obtained to evaluate the etiology of heart failure, thus reducing the occurrence of end-stage heart failure and decreasing the number of patients requiring heart transplantation.
authors.affiliation: Semmelweis University, Department of Cardiac Surgery, Budapest, Hungary. drharist@gmail.com
authors.forename: I
authors.initials: I
authors.lastname: Hartyánszky
authors.forename: E
authors.initials: E
authors.lastname: Tátrai
authors.forename: A
authors.initials: A
authors.lastname: Lászik
authors.forename: M
authors.initials: M
authors.lastname: Hubay
authors.forename: Z
authors.initials: Z
authors.lastname: Szelíd
authors.forename: G
authors.initials: G
authors.lastname: Acsády
authors.forename: Z
authors.initials: Z
authors.lastname: Szabolcs
authors.forename: B
authors.initials: B
authors.lastname: Merkely
authors.forename: F
authors.initials: F
authors.lastname: Horkay
authors.forename: P
authors.initials: P
authors.lastname: Sótonyi
mesh_terms: D000328:Adult; D001706:Biopsy; D002311:Cardiomyopathy, Dilated / Q000601:surgery* / Q000821:virology; D016022:Case-Control Studies; D004279:DNA, Viral / Q000302:isolation & purification*; D018450:Disease Progression; D005188:False Negative Reactions; D005260:Female; D006333:Heart Failure / Q000601:surgery* / Q000821:virology; D016027:Heart Transplantation; D006352:Heart Ventricles / Q000821:virology*; D006801:Humans; D006814:Hungary; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000175:diagnosis / Q000821:virology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D020133:Reverse Transcriptase Polymerase Chain Reaction
chemical_list: D004279:DNA, Viral