Recent-onset dilated cardiomyopathy associated with Borrelia burgdorferi infection.
BACKGROUND
Several recent small studies have suggested a causal link between Lyme disease and dilated cardiomyopathy (DCM) by demonstrating the presence of the Borrelia burgdorferi (Bb) genome in the myocardium of patients with recent-onset DCM. The aim of this study was to further investigate the effect of targeted antibiotic treatment of Bb-related recent-onset DCM in a larger cohort of patients.


METHODS
We performed endomyocardial biopsy (EMB) in 110 individuals (53 ± 11 years, 34 women) with recent-onset unexplained DCM, and detected the Bb genome in 22 (20 %) subjects. Bb-positive patients were subsequently treated with intravenous ceftriaxone for 21 days in addition to conventional heart failure medication.


RESULTS
At the 1-year follow-up, a significant improvement in left ventricular (LV) ejection fraction (26 ± 6  vs. 44 ± 12 %; p < 0.01) and a decrease in LV end-diastolic (69 ± 7 vs. 63 ± 11 mm; p < 0.01) and end-systolic (61 ± 9 vs. 52 ± 4 mm; p < 0.01) diameters were documented. Moreover, a significant improvement in heart failure symptoms (NYHA class 3.4 ± 0.6 vs. 1.5 ± 0.7; p < 0.01) was also observed.


CONCLUSIONS
Targeted antibiotic treatment of Bb-related recent-onset DCM in addition to conventional heart failure therapy is associated with favorable cardiac remodeling and improvement of heart failure symptoms.
2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 08, Prague 2, Czech Republic.|International Clinical Research Center, St. Anne's University Hospital in Brno, Brno, Czech Republic.
Petr
P
Kuchynka
2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 08, Prague 2, Czech Republic. tpalec@lf1.cuni.cz.|International Clinical Research Center, St. Anne's University Hospital in Brno, Brno, Czech Republic. tpalec@lf1.cuni.cz.
Tomas
T
Palecek
2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 08, Prague 2, Czech Republic.
Stepan
S
Havranek
Institute of Pathology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
Ivana
I
Vitkova
2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 08, Prague 2, Czech Republic.
Eduard
E
Nemecek
2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 08, Prague 2, Czech Republic.
Radka
R
Trckova
The National Institute of Public Health, Prague, Czech Republic.
Dagmar
D
Berenová
The National Institute of Public Health, Prague, Czech Republic.
Daniel
D
Krsek
2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 08, Prague 2, Czech Republic.
Jana
J
Podzimkova
2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 08, Prague 2, Czech Republic.
Michal
M
Fikrle
2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 08, Prague 2, Czech Republic.
Barbara Anna
BA
Danek
2nd Department of Medicine-Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, U Nemocnice 2, 128 08, Prague 2, Czech Republic.
Ales
A
Linhart
D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D025065:Borrelia burgdorferi / Q000302:isolation & purification*; D002311:Cardiomyopathy, Dilated / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology*; D002316:Cardiotonic Agents / Q000008:administration & dosage; D002443:Ceftriaxone / Q000008:administration & dosage; D004359:Drug Therapy, Combination / Q000379:methods; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology*; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008193:Lyme Disease / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D002316:Cardiotonic Agents; D002443:Ceftriaxone
Antibiotics; Borrelia burgdorferi; Dilated cardiomyopathy; Endomyocardial biopsy; Lyme disease