title: The Impact of Specific Viruses on Clinical Outcome in Children Presenting with Acute Heart Failure.
abstract: The presence and type of viral genomes have been suggested as the main etiology for inflammatory dilated cardiomyopathy. Information on the clinical implication of this finding in a large population of children is lacking. We evaluated the prevalence, type, and clinical impact of specific viral genomes in endomyocardial biopsies (EMB) collected between 2001 and 2013 among 63 children admitted to our hospital for acute heart failure (median age 2.8 years). Viral genome was searched by polymerase chain reaction (PCR). Patients underwent a complete two-dimensional echocardiographic examination at hospital admission and at discharge and were followed-up for 10 years. Twenty-seven adverse events (7 deaths and 20 cardiac transplantations) occurred during the follow-up. Viral genome was amplified in 19/63 biopsies (35%); PVB19 was the most commonly isolated virus. Presence of specific viral genome was associated with a significant recovery in ejection fraction, compared to patients without viral evidence (p < 0.05). In Cox-regression analysis, higher survival rate was related to virus-positive biopsies (p < 0.05). When comparing long-term prognosis among different viral groups, a trend towards better prognosis was observed in the presence of isolated Parvovirus B19 (PVB19) (p = 0.07). In our series, presence of a virus-positive EMB (mainly PVB19) was associated with improvement over time in cardiac function and better long-term prognosis.
authors.affiliation: Medical and Surgical Department of Cardiology, Children's Hospital Bambino Gesù, Piazza S. Onofrio 4, 00165 Rome, Italy. mgiulia.gagliardi@opbg.net.
authors.forename: Maria Giulia
authors.initials: MG
authors.lastname: Gagliardi
authors.affiliation: Immuno-Infectivology and Clinical Trials Area, Children's Hospital Bambino Gesù, Viale S. Paolo 15, 00146 Rome, Italy. alessandra.fierabracci@opbg.net.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Fierabracci
authors.affiliation: Medical and Surgical Department of Cardiology, Children's Hospital Bambino Gesù, Piazza S. Onofrio 4, 00165 Rome, Italy. mara.pilati@opbg.net.
authors.forename: Mara
authors.initials: M
authors.lastname: Pilati
authors.affiliation: Medical and Surgical Department of Cardiology, Children's Hospital Bambino Gesù, Piazza S. Onofrio 4, 00165 Rome, Italy. marcello.chinali@opbg.net.
authors.forename: Marcello
authors.initials: M
authors.lastname: Chinali
authors.affiliation: Operative Unit and Chair of Cardiac Surgery, Tor Vergata University, Viale Oxford 81, 00133 Rome, Italy. carlo.bassano@uniroma2.it.
authors.forename: Carlo
authors.initials: C
authors.lastname: Bassano
authors.affiliation: Department of Laboratory Medicine, Children's Hospital Bambino Gesù, Piazza S. Onofrio 4, 00165 Rome, Italy. francesca.saura@opbg.net.
authors.forename: Francesca
authors.initials: F
authors.lastname: Saura
authors.affiliation: Department of Pathology, Children's Hospital Bambino Gesù, Piazza S. Onofrio 4, 00165 Rome, Italy. isabella.g@fastwebnet.it.
authors.forename: Isabella
authors.initials: I
authors.lastname: Giovannoni
authors.affiliation: Department of Pathology, Children's Hospital Bambino Gesù, Piazza S. Onofrio 4, 00165 Rome, Italy. paola.francalanci@opbg.net.
authors.forename: Paola
authors.initials: P
authors.lastname: Francalanci
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D001706:Biopsy; D002311:Cardiomyopathy, Dilated / Q000209:etiology / Q000821:virology; D002648:Child; D002675:Child, Preschool; D004279:DNA, Viral / Q000235:genetics / Q000378:metabolism; D005260:Female; D005500:Follow-Up Studies; D006321:Heart / Q000821:virology; D006333:Heart Failure / Q000209:etiology* / Q000401:mortality / Q000821:virology; D006801:Humans; D007223:Infant; D008137:Longitudinal Studies; D008297:Male; D009205:Myocarditis / Q000209:etiology / Q000821:virology; D009206:Myocardium / Q000473:pathology; D010322:Parvoviridae Infections / Q000150:complications* / Q000821:virology; D016732:Parvovirus B19, Human / Q000235:genetics / Q000302:isolation & purification*; D016133:Polymerase Chain Reaction; D011379:Prognosis; D016016:Proportional Hazards Models; D016277:Ventricular Function, Left / Q000502:physiology; D055815:Young Adult
chemical_list: D004279:DNA, Viral
keywords: biopsy; cardiomyopathy; echocardiography; longitudinal study; myocarditis; pediatric; virus