Frequent detection of parvovirus B19 genome in the myocardium of adult patients with idiopathic dilated cardiomyopathy

Abstract

Aside from enteroviruses and other viruses, e.g., adenoviruses, which are known to be associated with idiopathic dilated cardiomyopathy (IDC), a cardiac tropism is also attributed to parvovirus B19 (PVB19). The purpose of the present study was to determine the prevalence of enterovirus, adenovirus and PVB19 genomes in the myocardium of adult patients with IDC and to analyze the significance of PVB19 with regard to the course of the disease, as compared to the other cardiotropic viruses. In 52 adult patients with IDC and 10 control patients with normal left ventricular ejection fraction (> or =55%) undergoing coronary artery bypass surgery, myocardial tissue samples were investigated for enteroviral RNA using polymerase chain reaction (PCR) and Southern blot hybridization of the PCR product. Specific nested PCR was used to assess the prevalence of adenovirus and PVB19 DNA, in addition to sequencing of the latter. The clinical and echocardiographic course of the disease was followed for a mean (+/- SD) period of 21.1+/-9.5 months. Fourteen of the 52 patients (27%) were enterovirus-positive, 2/52 (4%) patients were adenovirus-positive, 14/52 (27%) patients were PVB19-positive, 8/52 (15%) patients were enterovirus plus PVB19-positive, and in 14/52 (27%) patients no viral genomes were found. Six patients died during the follow-up period, without any significant difference between the patient groups: 1/14 (7%) in the enterovirus-positive, 0/2 (0%) in the adenovirus-positive, 2/14 (14%) in the PVB19-positive, 1/8 (12.5%) in the enterovirus plus PVB19-positive, and 2/14 (14%) in the virus-negative group. PVB19 genome was found in 4 of the 10 (40%) control patients, but no enterovirus or adenovirus genomes were detected in these patients. In conclusion, in the myocardium of patients with IDC, PVB19 is detectable as frequently as enteroviral genome. PVB19-positive patients with IDC have a rather favorable prognosis and do not differ significantly from the other virus-positive or virus-negative patient groups with respect to survival. Finally, the pathogenetic and prognostic significance of PVB19 in IDC still remains unclear.

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

“…These findings support the postulation of Bowles et al that different viruses have various pathogenic mechanisms such as lymphocyte-dependent vs. macrophage-dependent (Bowles et al, 2005). Nevertheless, PVB19 DNA has also been revealed in the myocardium of healthy donors (Donosa et al, 2005), in hearts of adults with dilated cardiomyopathy (Lotze et al, 2004), and in hearts of the patients with lupus and amyloidosis (Kuethe et al, 2007), despite the number of subjects studies was small. From these results, the question arises whether PVB19 certainly cause the underlying heart disease or whether it is just spectator attending in the heart as a result of former infection which is usual in young adults or children.…”

High Prevalence of Human Parvovirus B19 DNA in Myocardial Autopsy Samples from Subjects without Myocarditis or Dilative Cardiomyopathy

“…Several authors have postulated a causative role of B19 in cardiac disease, such as acute myocarditis (5,17,27), dilative cardiomyopathy or idiopathic left ventricular dysfunction (7,14,16,19), and peripartum cardiomyopathy (3). A search of the Internet on "parvovirus, human, cardiac disease" yields more than 100 hits in 29 publications since 2005.…”

“…Based on the amplification of B19 genome sequences from tissue samples, an association with chronic arthropathy (6,12) and acute fulminant liver failure in children (13), as well as with several entities of cardiac disease, i.e., acute myocarditis (5,27), dilative cardiomyopathy or idiopathic left ventricular dysfunction (14,16,19), and peripartum cardiomyopathy (3), was suggested.…”

Low level myocardial parvovirus B19 persistence is a frequent finding in patients with heart disease but unrelated to ongoing myocardial injury

“…Molecular virological analyses for B19V, EV and ADV genomes were performed on the remaining six endomyocardial biopsies as well as on the myocardial tissue samples of the right atrial appendage obtained from the control patients during the surgical procedure, according to the previously described protocol [Lotze et al, 2004].…”

“…Detection of B19V, EV and ADV genomes was performed using nested polymerase chain reaction (PCR) or reverse transcription-polymerase chain reaction (RT-PCR), respectively [Lotze et al, 2004]. Successful isolation of intact viral DNA and total RNA was proved by amplifying the housekeeping gene glyceraldehyde-3-phosphate-dehydrogenase in a nested PCR [Bültmann et al, 2003].…”