Absence of Borrelia burgdorferi in the myocardium of subjects with normal left ventricular systolic function: a study using PCR and electron microscopy.
BACKGROUND
Several studies have demonstrated the presence of the Borrelia burgdorferi (Bb) genome in the myocardium of patients with dilated cardiomyopathy (DCM). To further support a causal relationship between the presence of Bb in the heart muscle and the development of DCM, demonstration of the absence of Bb in the myocardium of subjects with normal left ventricular (LV) systolic function is needed.


OBJECTIVE
To determine the prevalence of Bb by polymerase chain reaction (PCR) and electron microscopy (EM) in individuals with normal LV systolic function and no history suggestive of myocarditis.


METHODS
We investigated 50 patients (67 ± 9 years, 15 women) with normal LV ejection fraction (EF) ≥ 50% undergoing cardiac surgery. During surgery, four samples from the right atrial appendage were obtained and subsequently examined by PCR and EM for the presence of Bb, and by immunohistochemistry to detect inflammatory cells. Serological testing of antibodies against Bb was also performed.


RESULTS
Neither PCR nor EM detected Bb in any of the subjects. Immunohistological examination revealed myocardial inflammation in 2 individuals (4%). Serological analysis by enzyme-linked immunosorbent assay demonstrated IgM antibodies against Bb in 4% and IgG antibodies in 12% of the study cohort; Western blot revealed IgM as well as IgG positivity in 14% of patients.


CONCLUSIONS
The absence of Bb in the myocardium of individuals who undergo cardiac surgery and have normal LV systolic function supports the idea of Bb pathogenicity in the development of DCM.
2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic.|International Clinical Research Center, St. Anne's University Hospital in 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, Czech Republic.|International Clinical Research Center, St. Anne's University Hospital in Brno, Czech Republic.
Tomas
T
Palecek
2nd Department of Surgery - Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic.
Tomas
T
Grus
2nd Department of Surgery - Department of Cardiovascular Surgery, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic.
Jaroslav
J
Lindner
National Institute of Public Health, Prague, Czech Republic.
Dagmar
D
Berenova
National Institute of Public Health, Prague, Czech Republic.
Zuzana
Z
Kurzova
National Institute of Public Health, Prague, Czech Republic.
Pavla
P
Balatova
National Institute of Public Health, Prague, Czech Republic.
Daniel
D
Krsek
Institute of Pathology, First Faculty of Medicine, Charles University in Prague and General University Hospital in 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, 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, 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, Czech Republic.
Anna Barbara
AB
Danek
2nd Department of Medicine - Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Czech Republic.
Ales
A
Linhart
D000368:Aged; D025065:Borrelia burgdorferi / Q000302:isolation & purification*; D002311:Cardiomyopathy, Dilated / Q000382:microbiology* / Q000503:physiopathology; D004797:Enzyme-Linked Immunosorbent Assay; D005260:Female; D006321:Heart / Q000382:microbiology*; D006801:Humans; D008193:Lyme Disease / Q000473:pathology* / Q000503:physiopathology; D008297:Male; D008854:Microscopy, Electron / Q000379:methods; D009205:Myocarditis / Q000382:microbiology / Q000503:physiopathology; D009206:Myocardium / Q000473:pathology*; D016133:Polymerase Chain Reaction / Q000379:methods; D011446:Prospective Studies; D016277:Ventricular Function, Left / Q000502:physiology
Borrelia burgdorferi; dilated cardiomyopathy; myocarditis; myocardium