Interferon β-1b Therapy in Chronic Viral Dilated Cardiomyopathy—Is There a Role for Specific Therapy?

Zimmermann, Oliver; Rodewald, Christoph; Radermacher, Michael; Vetter, Martin; Wiehe, Juliane M.; Bienek-Ziolkowski, Magdalena; Hombach, Vinzenz; Torzewski, Jan

doi:10.1016/j.cardfail.2009.12.016

Cited by 24 publications

(16 citation statements)

References 35 publications

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“…When taken together, our data are consistent with the notion that parvovirus B19 is widely present in the general population [19,21,38], and do not support a role for this virus as a specific causative agent of DCM. In agreement with our results, in a recent case-control study, therapy with Interferon-␤ failed in improving clinical status and functional characteristics of patients with DCM and viral myocardial persistence (92% positive for parvovirus B19) [39].…”

Section: Discussionsupporting

confidence: 92%

Idiopathic dilated cardiomyopathy and persistent viral infection: Lack of association in a controlled study using a quantitative assay

Moimas

Zacchigna

Merlo

et al. 2012

Heart, Lung and Circulation

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Section: Discussionsupporting

confidence: 92%

Idiopathic dilated cardiomyopathy and persistent viral infection: Lack of association in a controlled study using a quantitative assay

Moimas

Zacchigna

Merlo

et al. 2012

Heart, Lung and Circulation

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“…However, a more recent, longer term follow-up trial (36 months) could not confirm the promising results from pilot studies and showed no significant clinical benefit conferred by interferon therapy in HF patients. Of interest, the lack of therapeutic effect in this recent trial was postulated to be due to the presence of parvovirus B19 in many of the virus-positive subjects35. While antiviral therapy may be of benefit for parvovirus B19-associated myocarditis in children24 in whom primary (acute) infection is more common25, our results support recent studies35 and argue against the use of antiviral therapy in adult HF patients with parvovirus persistence.…”

Section: Discussionsupporting

confidence: 76%

Myocardial Parvovirus B19 Persistence

Stewart

Lopez-Molina

Gottumukkala

et al. 2011

Circ: Heart Failure

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Background-Multiple viruses have been isolated from the heart, but their significance remains controversial. We sought to determine the prevalence of cardiotropic viruses in endomyocardial biopsy (EMB) samples from adult patients with heart failure (HF) and to define the clinicopathologic profile of patients exhibiting viral positivity. Methods and Results-EMB from 100 patients (median ejection fraction, 30%; interquartile range [IQR], 20% to 45%) presenting for cardiomyopathy evaluation (median symptom duration, 5 months; IQR, 1 to 13 months) were analyzed by polymerase chain reaction for adenovirus, cytomegalovirus, enteroviruses, Epstein-Barr virus, and parvovirus B19. Each isolate was sequenced, and viral load was determined. Parvovirus B19 was the only virus detected in EMB samples (12% of subjects). No patient had antiparvovirus IgM antibodies, but all had IgG antibodies, suggesting viral persistence. The clinical presentation of parvovirus-positive patients was markedly heterogeneous with both acute and chronic HF, variable ventricular function, and ischemic cardiomyopathy. No patient met Dallas histopathologic criteria for active or borderline myocarditis. Two patients with a positive cardiac MRI and presumed "parvomyocarditis" had similar viral loads to autopsy controls without heart disease. The oldest parvovirus-positive patients were positive for genotype 2, suggesting lifelong persistence in the myocardium. Conclusions-Parvovirus B19 was the only virus isolated from EMB samples in this series of adult patients with HF from the United States. Positivity was associated with a wide array of clinical presentations and HF phenotypes. Our studies do not support a causative role for parvovirus B19 persistence in HF and, therefore, advocate against the use of antiviral therapy for these patients. (Circ Heart Fail. 2011;4:71-78.)

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“…The study included 110 patients, 42 treated with interferon-β and 68 assigned to the non-treatment control group. In contrast to the promising results observed in case reports and pilot studies, no benefit on clinical outcome was observed (Zimmermann, et al, 2010). Nonetheless, successful case reports continue to emerge.…”

Section: Antiviral Treatment Of Myocarditiscontrasting

confidence: 46%