Meta-analysis of the association of enteroviruses with human heart disease

Abstract

The role of viruses in the genesis of both dilated cardiomyopathy (DCM) and acute myocarditis remains uncertain. Modern molecular techniques such as polymerase chain reaction (PCR) and in situ hybridisation are sensitive means of detecting viral genomic material in human myocardial tissue and may help to resolve the quest. Meta-analysis of the papers in the literature records studies of both acute myocarditis and DCM where molecular techniques were used to demonstrate enteroviruses. This review studies information from the published literature as well as statistical analysis of the cumulative molecular data relating enteroviruses to DCM, and to compare these findings with the information available on the role of enteroviruses in acute myocarditis. Twelve papers reported studies in acute myocarditis, of which 11 found higher percentages of enteroviral RNA positivity in the diseased population, giving an overall odds ratio of 4.4. Seventeen papers reported studies in DCM, with 11 recording higher positivity rates in these patients. Cumulative analysis of these data suggests an overall odds ratio of 3.8. The causative role of enteroviruses in acute myocarditis, particularly in children, is supported by meta-analysis of the available literature. The data on DCM is suggestive of an association but a proportion of the studies are negative.

Hepatitis C Virus from the Hearts of Patients with Myocarditis and Cardiomyopathy

“…Persistent enterovirus infection of the myocardium has been reported (Bowles et al, 1986;Kandolf et al, 1987), and the existence of a causative role of enteroviruses in acute myocarditis, particularly in children, finds support in a metaanalysis. On the other hand, some of the studies examining the association of enteroviruses with dilated cardiomyopathy have been negative (Baboonian and Treasure, 1997). Etiologic roles for other viruses, particularly adenovirus and cytomegalovirus (Schonian et al, 1995) have also been reported.…”

Myocarditis in Childhood: An Update on Etiology, Diagnosis and Management

“…The causes other than infections are autoimmune-systemic diseases, toxins and hypersensitivity to drugs (Brodison & Swann, 2001). Enteroviruses (particularly Coxsackie) and adenovirus were recognized as the major cause of viral myocarditis (Baboonian& Treasure, 1997;Pauschinger et al, 1999). During the last decade, parvovirus B19 (PVB19) and human herpesvirus 6 (HHV6) have been described as new pathogens .…”

Cellular and biomolecular mechanisms in dilated cardiomyopathy

“…This hypothesis becomes questionable because the enteroviral RNA proportion usually detected through PCR in these hearts is small and localized 19 . On the other hand, experimental myocarditis models show that some coxsackievirus B-3 strains have greater cardiovirulence 20 . It is predicted that methods will be developed in the future that will be able to distinguish whether or not the identified genomes are related to strains with greater pathogenic potential.…”

“…Negative results were also obtained by some researchers 15,16 . However, meta-analysis of data from several studies that used PCR or in situ hybridization suggests a possible association between enterovirus infections and DCM 20 . Interpretation of these data should take into account methodological differences related to the technique applied and selection of patients and control groups.…”