Prevalence of Viral Genome in Endomyocardial Biopsies from Patients with Inflammatory Heart Muscle Disease

Abstract

In the report of the 1995 World Health Federation/International Society and Federation of Cardiology (WHF/ISFC) Task Force on the Definition and Classification of Cardiomyopathies, the definition of heart muscle diseases was updated. Idiopathic, autoimmune, and infectious forms of inflammatory cardiomyopathy are now recognized in this definition. Enteroviruses, adenoviruses and cytomegaloviruses are considered as main etiopathological factors in the pathogenesis of inflammatory heart disease. A wide range of different assays have been and are currently being used, either alone or in combination, to assay for the presence of enteroviral RNA and/or DNA of cytomegalo- and adenoviruses in endomyocardial biopsy and explanted heart samples. The prevalence of cardiotropic viruses in endomyocardial biopsies of patients with clinically suspected inflammatory cardiomyopathy varies widely: enteroviral genome was detected in endomyocardial biopsies of 3 to 53% of patients, cytomegaloviral DNA was detected in 3 to 40% of patients with inflammatory heart disease and adenoviruses in 3 to 23% of the patients. This report summarizes the methods that have been used and the results of molecular biological investigation with polymerase chain reaction, which were reported by several groups over the last years. Taking this together it seems to be clear that the improvement of molecular biological techniques and the experience of people working with these methods will lead to more reliable results on prevalence, persistence and the diagnostic value of these investigations. These findings have to be taken into account in future diagnostic and therapeutic studies in the field of cardiomyopathies.

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

“…In 1 investigation using PCR, evidence of viral infection was found in 68% of 38 patients with clinically suspected MC. 6 A number of viruses have been associated with MC in humans; however, coxsackie group B (CB) virus is considered the predominant etiological agent. 1 The CB type 3 virus has a natural tropism for cardiomyocytes, and uses the CB-adenoviral common receptor to gain entry into host cells, 7 resulting in the production of protease 2A, which cleaves the structures of the myocyte skeleton.…”

Histologic and In Situ Viral Findings in the Myocardium in Cases of Sudden, Unexpected Death

“…In cases of sudden, unexpected death, serology is usually not available, and viral cultures have relatively low sensitivity, especially in the autopsy setting (8). In situ hybridization analyses for DNA viruses, which are associated with high copy number, show both high sensitivity and specificity, as documented in cases of cytomegalovirus and adenovirus-associated myocarditis (12)(13)(14). However, most cases of viral myocarditis are associated with RNA viruses, in which the viral genome number may be below the detection threshold of the assay, which is about 10 copies per cell (15)(16)(17).…”

Familiäre Prädisposition und mikrobielle Ätiologie bei dilatativer Kardiomyopathie

“…Genetische, (auto)immune und virale Faktoren werden in der Ätiologie und Pathogenese der DCM diskutiert (Abbildung 2), vermutlich sind aber alle drei Faktoren in unterschiedlicher Ausprägung beteiligt [3][4][5][6]. Familiäre Formen scheinen bis zu 30% der Fälle auszumachen [7].…”

“…Zunächst stand der Nachweis von Entero-, Adeno-und Zytomegalieviren im Vordergrund, wobei am häu-figsten Enteroviren mit einer Prävalenz von bis zu 57% bei Patienten mit Myokarditis und bis zu 28% bei Patienten mit DCM im europäischen und amerikanischen Raum nachweisbar waren [4,29]. Inzwischen werden vor allem im europäischen Raum bei Patienten mit dilatativen und entzündlichen Herzmuskelerkrankungen "neue" kardiotrope Erreger mit hohen Prävalenzen wie z.B.…”