Low frequency of detection by nested polymerase chain reaction of enterovirus ribonucleic acid in endomyocardial tissue of patients with idiopathic dilated cardiomyopathy

Abstract

This study suggests that the persistence of enteroviral RNA in dilated cardiomyopathy is not a major cause of the disease and that a careful analysis of polymerase chain reaction amplification products is essential in any study in which this technique is pushed to high sensitivity thresholds.

Arrhythmogenic Right Ventricular Cardiomyopathy and Fatty Replacement of the Right Ventricular Myocardium

“…15 However, this study does not rule out the possibility that inflammation is a superimposed process, as favored by Fontaine et al 16 It remains to be proven whether fibrofatty ARVC is ever the result of a previous viral infection, as molecular studies for enteroviral RNA suggest in a small proportion of cases of idiopathic dilated cardiomyopathy. 17 The present study demonstrates that with extensive sampling of the left ventricular myocardium, fibrofatty replacement of the epicardium may be found in a majority of cases of fibrofatty ARVC. The regional distribution of fibroinflammatory lesions in fibrofatty ARVC primarily in the right ventricle and secondarily in the left ventricular epicardial location is characteristic of the disease.…”

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 .…”

“…The advent of new techniques of molecular biology based upon nucleic acid hybridization, made enteroviral RNA detection possible in up to 43% and 47% of the samples containing myocardial tissue of patients with DCM and myocarditis, respectively 13,14 . Later determinations using the polymerase chain reaction (PCR) technique, more sensitive and specific, observed the presence of enteroviral genomes in 0% to 67% of the biopsies evaluated [15][16][17][18][19] . Although significantly high numbers were reported 18 , a similar proportion of enterovirus RNA was also seen in the DCM group in relation to controls 17 .…”

Clinical Presentation

“…These abnormalities in immune regulation and the variety of antimyocardial antibodies present in DCM are consistent with this hypothesis. Enteroviral RNA sequences may be found in heart biopsy samples in DCM but with a very variable frequency (0-30 percent), (Bowles et al, 1986;Giacca et al, 1994). Furthermore, analysis of human viruses other than enteroviruses suggests that adenoviruses, herpes, and cytomegalovirus can also cause myocarditis and potentially DCM, particularly in children and young subjects (Martin et al, 1994;Pauschinger et al, 1999).…”