title: Aggravation of left ventricular dysfunction in patients with biopsy-proven cardiac human herpesvirus A and B infection.
abstract: BACKGROUND
  Human herpesvirus 6 (HHV-6) A and B are lymphotropic viruses with life-long persistence, primarily associated with non-cardiac diseases, and discussed as a possible etiologic factor of myocarditis and cardiomyopathy.
  
  
  OBJECTIVE
  To analyze the long-term spontaneous course of cardiac patients suffering from suspected inflammatory cardiomyopathy (CMi) with persisting HHV-6 A and B infections by follow-up biopsies.
  
  
  METHODS
  We prospectively evaluated patients (n=73) with biopsy-proven viral HHV-6 A and B infection in endomyocardial biopsies (EMBs), followed up by reanalysis of EMBs and left ventricular ejection fraction (LV-EF) measurements after a median period of 8.8 months (range 4-73 months). Beyond, we studied HHV-6 prevalence in isolated peripheral blood cells (PBCs) and HHV-6 species in EMBs. HHV-6 species-specific cellular infection sites within the myocardium were identified by immunohistochemistry (IHC).
  
  
  RESULTS
  We identified 73 patients with cardiac HHV-6 A and B persistence or newly detected in follow-up EMB (95.0% B). Proof of HHV-6 in PBCs was primarily associated with A. Persistence of cardiac HHV-6 B genome was significantly associated with cardiac dysfunction at follow-up (LV-EF deteriorated from 58.2±16.0 to 51.8±17.2%, p<0.001), and LV improvement was observed when HHV-6 B persistence resolved (LV-EF increased from 54.9±15.4 to 60.7±13.1%, p<0.001).
  
  
  CONCLUSIONS
  Persistence of cardiac HHV-6 B genomes was significantly associated with cardiac dysfunction, and hemodynamic parameters improved in association with HHV-6 B clearance.
authors.affiliation: Department of Cardiology and Pneumology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany; Institut für Kardiale Diagnostik und Therapie (IKDT), Berlin, Germany. Electronic address: felicitas.escher@charite.de.
authors.forename: F
authors.initials: F
authors.lastname: Escher
authors.affiliation: Department of Cardiology and Pneumology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany; Institut für Kardiale Diagnostik und Therapie (IKDT), Berlin, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Kühl
authors.affiliation: Institut für Kardiale Diagnostik und Therapie (IKDT), Berlin, Germany.
authors.forename: U
authors.initials: U
authors.lastname: Gross
authors.affiliation: University Heart Centre Hamburg, Hamburg, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Westermann
authors.affiliation: Department of Cardiology and Pneumology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: W
authors.initials: W
authors.lastname: Poller
authors.affiliation: Department of Cardiology and Pneumology, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Germany.
authors.forename: C
authors.initials: C
authors.lastname: Tschöpe
authors.affiliation: Institut für Kardiale Diagnostik und Therapie (IKDT), Berlin, Germany.
authors.forename: D
authors.initials: D
authors.lastname: Lassner
authors.affiliation: Institut für Kardiale Diagnostik und Therapie (IKDT), Berlin, Germany.
authors.forename: H-P
authors.initials: HP
authors.lastname: Schultheiss
mesh_terms: D000328:Adult; D000368:Aged; D001706:Biopsy; D001769:Blood / Q000821:virology; D009202:Cardiomyopathies / Q000473:pathology* / Q000821:virology*; D005260:Female; D006321:Heart / Q000821:virology*; D015654:Herpesvirus 6, Human / Q000145:classification / Q000302:isolation & purification*; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology; D011446:Prospective Studies; D019349:Roseolovirus Infections / Q000150:complications* / Q000821:virology; D018487:Ventricular Dysfunction, Left / Q000503:physiopathology*
keywords: HHV6; Heart; Heart failure; Inflammatory cardiomyopathy; Prognosis