title: A high frequency of viral agents yet absence of Borrelia burgdorferi is seen within the myocardium of subjects with normal left ventricular systolic function: an electron microscopy study.
abstract: A wide range of viral agents is associated with the development of acute myocarditis and its possible chronic sequela, dilated cardiomyopathy (DCM). There is also increasing evidence that Borrelia burgdorferi (Bb) is associated with DCM in endemic regions for Bb infection. This study sought to use electron microscopy to prospectively analyze the presence of viruses and Bb within the myocardium of 40 subjects with preserved left ventricular (LV) ejection fraction and 40 patients with new-onset unexplained DCM during the same time period. Virus particles were found within the myocardium of 23 subjects (58%) of both cohorts studied, yet there was no statistically significant difference in virus family presence between those with DCM versus those with preserved LV systolic function. In contrast, Bb was detected only in those subjects with DCM (0 versus 5 subjects; p ˂ 0.05). Polymerase chain reaction was performed on samples from patients who were positive for Bb according to electron microscopy, and Bb was confirmed in 4 out of 5 individuals. Our results demonstrate that the prevalence of viral particles does not differ between subjects with preserved LV systolic function versus those with DCM and therefore suggests that the mere presence of a viral agent within the myocardium is not sufficient to establish a clear link with the development of DCM. In contrast, the presence of Bb was found only within myocardial samples of patients with DCM; this finding supports the idea of a causal relationship between Bb infection and DCM development.
authors.affiliation: 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.
authors.forename: Petr
authors.initials: P
authors.lastname: Kuchynka
authors.affiliation: 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.
authors.forename: Tomas
authors.initials: T
authors.lastname: Palecek
authors.affiliation: 2nd Department of Surgery, Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
authors.forename: Tomas
authors.initials: T
authors.lastname: Grus
authors.affiliation: The National Institute of Public Health, Prague, Czech Republic.
authors.forename: Jana
authors.initials: J
authors.lastname: Schramlova
authors.affiliation: The National Institute of Public Health, Prague, Czech Republic.
authors.forename: Daniel
authors.initials: D
authors.lastname: Krsek
authors.affiliation: Institute of Pathology, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
authors.forename: Ivana
authors.initials: I
authors.lastname: Vitkova
authors.affiliation: 2nd Department of Surgery, Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
authors.forename: Vilem
authors.initials: V
authors.lastname: Rohn
authors.affiliation: 2nd Department of Surgery, Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic.
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Lindner
authors.affiliation: The Heart Hospital, University College London, London, Great Britain.
authors.forename: Eleanor
authors.initials: E
authors.lastname: Wicks
authors.affiliation: 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.
authors.forename: Eduard
authors.initials: E
authors.lastname: Nemecek
authors.affiliation: 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.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Dostalova
authors.affiliation: 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.
authors.forename: Jana
authors.initials: J
authors.lastname: Podzimkova
authors.affiliation: 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.
authors.forename: Ales
authors.initials: A
authors.lastname: Linhart
mesh_terms: D000368:Aged; D000998:Antiviral Agents / Q000009:adverse effects / Q000627:therapeutic use; D001794:Blood Pressure; D025065:Borrelia burgdorferi / Q000235:genetics / Q000302:isolation & purification / Q000502:physiology* / Q000648:ultrastructure; D002311:Cardiomyopathy, Dilated / Q000382:microbiology* / Q000503:physiopathology / Q000821:virology; D005260:Female; D006321:Heart / Q000382:microbiology / Q000503:physiopathology / Q000821:virology; D006801:Humans; D008193:Lyme Disease / Q000145:classification / Q000382:microbiology / Q000503:physiopathology; D008297:Male; D008854:Microscopy, Electron; D008875:Middle Aged; D009206:Myocardium / Q000648:ultrastructure; D011446:Prospective Studies; D016277:Ventricular Function, Left; D014777:Virus Diseases / Q000150:complications* / Q000188:drug therapy / Q000821:virology; D014780:Viruses / Q000145:classification / Q000235:genetics / Q000302:isolation & purification / Q000648:ultrastructure
chemical_list: D000998:Antiviral Agents