title: Predictors of outcome in patients with parvovirus B19 positive endomyocardial biopsy.
abstract: OBJECTIVE
  Primary objective was to establish the prognostic value of the myocardial load of PVB19 genomes in patients presenting for work-up of myocarditis and/or unclear cardiomyopathy in comparison to clinical, and CMR parameters.
  
  
  METHODS
  108 consecutive patients who underwent EMB because of suspected myocarditis and/or unclear cardiomyopathy, and had evidence of myocardial PVB19 genome, were enrolled. Primary endpoint was all-cause mortality; secondary endpoint was a composite of cardiac mortality and hospitalization for heart failure.
  
  
  RESULTS
  Mean LV-EF was 40%. We found n = 27 patients to have a viral load ≥ 500 GE (IQR 559-846), n = 72 had 100-499 GE, and n = 9 had <100 GE. Immunohistology revealed chronic myocarditis in n = 66, acute myocarditis in n = 1, DCM in n = 17, PVB19 genome only in n = 13, and other pathologies in n = 11. During follow-up 11 patients died, two suffered SCD but were successfully shocked by ICD, and 21 were hospitalized for heart failure. Interestingly, not the viral load, but functional parameters such as LV-EF, LV-EDV (endpoint 2), as well as the histologic diagnosis of DCM and the presence of LGE (for all endpoints) reached statistical significance. In fact, the presence of LGE yields an odds-ratio for a lethal event of 8.56 (endpoint 1), and of 5.52 for endpoint 2. No patient with normal LV-EF, or the absence of LGE, suffered cardiac death during long-term follow-up.
  
  
  CONCLUSIONS
  The viral load of PVB19 genomes in the myocardium is not related to the long-term outcome. Furthermore, this study suggests a growing role of imaging for risk stratification in non-ischemic myocardial disease.
authors.affiliation: Division of Cardiology, Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany. simon.greulich@rbk.de.
authors.forename: Simon
authors.initials: S
authors.lastname: Greulich
authors.affiliation: Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Homburg/Saar, Germany.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Kindermann
authors.affiliation: Division of Cardiology, Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany.|Division of Cardiology, Horst-Schmidt-Kliniken, Wiesbaden, Germany.
authors.forename: Julia
authors.initials: J
authors.lastname: Schumm
authors.affiliation: Department of Medicine II, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany.
authors.forename: Andrea
authors.initials: A
authors.lastname: Perne
authors.affiliation: Division of Cardiology, Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Birkmeier
authors.affiliation: Division of Cardiology, Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Grün
authors.affiliation: Division of Cardiology, Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Ong
authors.affiliation: Division of Cardiology, Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany.
authors.forename: Tim
authors.initials: T
authors.lastname: Schäufele
authors.affiliation: Universitätsklinikum Tübingen, Abteilung für Molekulare Pathologie, Tübingen, Germany.
authors.forename: Karin
authors.initials: K
authors.lastname: Klingel
authors.affiliation: Institut für Herzinfarktforschung Ruhr, Essen, Germany.
authors.forename: Steffen
authors.initials: S
authors.lastname: Schneider
authors.affiliation: Universitätsklinikum Tübingen, Abteilung für Molekulare Pathologie, Tübingen, Germany.
authors.forename: Reinhard
authors.initials: R
authors.lastname: Kandolf
authors.affiliation: Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Homburg/Saar, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
authors.affiliation: Division of Cardiology, Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany.
authors.forename: Udo
authors.initials: U
authors.lastname: Sechtem
authors.affiliation: Division of Cardiology, Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany. Heiko.Mahrholdt@rbk.de.
authors.forename: Heiko
authors.initials: H
authors.lastname: Mahrholdt
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D001706:Biopsy; D009202:Cardiomyopathies / Q000175:diagnosis / Q000503:physiopathology / Q000821:virology*; D002908:Chronic Disease; D017147:Defibrillators, Implantable; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology / Q000628:therapy; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009205:Myocarditis / Q000175:diagnosis / Q000503:physiopathology / Q000821:virology*; D010322:Parvoviridae Infections / Q000175:diagnosis / Q000503:physiopathology* / Q000821:virology; D016732:Parvovirus B19, Human / Q000235:genetics / Q000302:isolation & purification*; D011379:Prognosis; D019562:Viral Load
keywords: Cardiovascular magnetic resonance; Mortality; Myocarditis; PVB19; Prognosis