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

Abstract

SUMMARY:The myocardium may be the target of several types of viral infections. The importance of hepatitis C virus (HCV) infection has been recently noted in patients with myocarditis and in patients with dilated or hypertrophic cardiomyopathy. The present study sought to detect HCV genomes in formalin-fixed paraffin sections of autopsied hearts from patients with myocarditis and patients with dilated or hypertrophic cardiomyopathy. Paraffin sections were deparaffinized, RNA was extracted, and the positive and negative strands of HCV RNA were detected by performing reverse transcription and nested polymerase chain reaction. The polymerase chain reaction products were cloned and sequenced. ␤-actin gene was used as a control for the successful amplification of a housekeeping gene. Among 106 hearts examined, ␤-actin gene was amplified in 61 hearts (57.5%). Among the latter, HCV RNA was detected in 13 hearts (21.3%), and negative strands in 4 hearts (6.6%). HCV RNA was found in 4 hearts (33.3%) with myocarditis, in 3 hearts (11.5%) with dilated cardiomyopathy, and in 6 hearts (26.0%) with hypertrophic cardiomyopathy. The sequences recovered from nine patients were highly homologous to the standard strain of HCV. HCV genomes were not found in either 35 hearts from patients with myocardial infarction or 20 hearts from patients with noncardiac diseases. These HCV RNA positive samples were obtained from 1 heart in 1979, 7 hearts between 1980 and 1989, and 5 hearts since 1990, indicating that HCV RNA can be amplified from paraffin-embedded hearts preserved for many years. This method of detecting HCV genomes in formalin-fixed paraffin cardiac specimens has enabled us to widen our research into HCV infection and has been helpful in identifying the presence of HCV infection in cardiac myopathic disorders. (Lab Invest 2000, 80:1137-1142.

Advances in the Understanding of Myocarditis

“…These include adenoviruses, which are being detected frequently in the younger population, 4 and hepatitis C virus. 7 Human immunodeficiency viral infection is frequently associated with myocardial decompensation. It appears that myocarditis is present in most of these cases.…”

Is hepatitis C virus a cause of idiopathic dilated cardiomyopathy? A systematic review of literature

“…Identification of HCV in patients with IDC was performed in most studies through RT-PCR (reverse trancription PCR) in myocardium samples obtained from heart biopsies or post mortem exams [12,[24][25][26]. However, Grumbach [27] and Dalekos et al [23] only examined sera samples.…”

“…A significant relation between dilated cardiomyopathy and HCV was found in only two studies (p = 0.039 and 0.0047, respectively) [12,24].…”

“…However, most papers at least excluded ischemic cardiomyopathy as an etiology, except for the study of Matsumori et al in autopsied patients [24].…”

“…One of them examined the possibility of there being various molecular mechanisms for the development of HCV-induced dilated and hypertrophic cardiomyopathy [24]. Among the articles selected for the systematic review, three of them were performed in Japan [12,24,25] and three in Europe [23,26,27]; some of them are cited many times in several international studies (Figure 1). Most of the articles received low classifications, based on the evaluation criteria of Figueiredo and Tavares-Neto, 2001 [31], demonstrating that these papers did not fulfill the systematization criteria.…”