High Prevalence of Cardiac Parvovirus B19 Infection in Patients With Isolated Left Ventricular Diastolic Dysfunction

Abstract

Background-The etiology of left ventricular (LV) isolated diastolic dysfunction often remains unclear. In the present study, we report a strong association between parvovirus B19 (PVB19) genomes and isolated LV diastolic dysfunction. Methods and Results-In 70 patients (meanϮSD age, 43Ϯ11 years) admitted with exertional dyspnea and/or reduced exercise tolerance despite preserved LV systolic contractility (ejection fractionϭ68%), isolated diastolic dysfunction was clinically suspected. Patients with classic risk factors for diastolic dysfunction such as hypertension, coronary heart disease, diabetes mellitus, or pulmonary disease had been excluded. Diastolic function was assessed by echocardiography and LV and RV catheterization. Endomyocardial biopsies (EMBs) were analyzed for the presence of storage or infiltrative diseases or myocarditis, including molecular screening for cardiotropic virus genomes. In a substudy of 24 patients who reported atypical angina, coronary endothelial function was additionally investigated with a coronary Doppler flow-wire technique. In 37 of 70 patients (53%), isolated diastolic dysfunction was confirmed as the cause of their clinical symptoms. No evidence for cardiac storage or infiltrative diseases was found in these cases, but in 35 of 37 of these patients (95%), cardiotropic virus genomes were detected in EMBs (PϽ0.001). PVB19 was the most frequent pathogen in 31 of 37 patients (84%). In a subgroup of 10 patients with diastolic dysfunction and coexisting endothelial dysfunction, all 10 (100%) were PVB19 positive. Conclusions-PVB19 genomes were predominant in patients with unexplained, isolated diastolic dysfunction. A strong association with the incidence of endothelial dysfunction was obvious, consistent with the hypothesis that PVB19-induced endothelial dysfunction may be a possible pathomechanism underlying diastolic dysfunction.

Impact of Comorbidities on Myocardial Remodeling and Dysfunction In Heart Failure with Preserved Ejection Fraction

“…Conversely, physical exercise, which improves endothelial dysfunction, was found to preserve LV compliance in elderly athletes compared to sedentary seniors [65]. As a result of coronary microvascular endothelial inflammation, the vasodilator response of the coronary microvascular bed to acetylcholine was reduced in HFpEF, which correlated with diastolic LV dysfunction [66]. Similar paracrine endocardialmyocardial interactions have previously already been reported [67].…”

Comparison of the Clinical Presentation, Treatment, and Outcome of Fulminant and Acute Myocarditis in Children

“…14 MC caused by infection with human parvovirus B19 (PV-B19) has been reported in infants with MC, 15 and the PV B19 genome was predominant in patients with unexplained isolated diastolic ventricular dysfunction. 16 PV-B19 is associated Table 2. SAJI T et al…”

Prevalence of hepatitis C and B virus infection in patients with idiopathic dilated cardiomyopathy in Brazil: a pilot study

“…Some studies support that viral infections would be related to the development of myocarditis and idiopathic dilated cardiomyopathy (IDCM), suggesting that the IDCM would be a result of a previous subclinical myocarditis. The viral infection has also been related with restrictive cardiomyopathy, as demonstrated by Tschope, Bock C-T et al in study with 70 patients that showed strong association between parvovirus B19 and isolated left ventricular diastolic dysfunction [12].…”