Viral genome changes and the impact of viral genome persistence in myocardium of patients with inflammatory cardiomyopathy

Abstract

IntroductionViral infections are considered the most frequent cause of myocarditis and dilated cardiomyopathy (DCM).Material and methodsWe investigated the changes in viral presence and the impact of viral genome persistence in the myocardium on echocardiographic parameters, functional status and some laboratory parameters in a 6-month follow-up. Fifty-four patients with recent onset DCM, left ventricular ejection fraction < 40% and biopsy-proven myocarditis (> 14 mononuclear leukocytes/mm2 and/or > 7 T-lymphocytes/mm2) were enrolled. Polymerase chain reaction (PCR) was performed to detect pathogens in the myocardium. Patients were divided according to the administered therapy: standard heart failure medication (46 patients) and immunosuppressive therapy (8 patients).ResultsIn the standard heart failure medication group viral clearance was observed in 13 patients and viral persistence in 24 patients in the follow-up period. Comparing both groups, there was no statistically significant difference – LVEF improvement of 12.0 ±11.4% vs. 18.3 ±12.6%, decrease in NYHA class of 0.7 ±0.7 vs. 1.0 ±0.7, decline in NT-proBNP of 1335 ±1933 ng/l vs. 1942 ±3242 ng/l and decrease in infiltrating leukocytes of 11.1 ±15.8 vs. 6.7 ±23.0 cells/mm2 and T-lymphocytes of 5.8 ±15.1 vs. 1.8 ±10.9 cells/mm2 (all p = NS). A decrease in PCR positive patients from 37 to 29 was observed. The number of PVB19 positive PCR findings decreased from 5 to 4 in patients with immunosuppressive therapy.ConclusionsA decrease in the number of positive PCR findings in control endomyocardial biopsy was observed. Viral genome persistence was not associated with worse outcome in short-term follow-up.

Twelve Month Kinetics of Circulating Fibrosis-Linked Micrornas (Mir-21, Mir-29, Mir-30, and Mir-133a) and the Relationship With Extracellular Matrix Fibrosis in Dilated Cardiomyopathy

“…If we had used non-invasive methods of fibrosis evaluation such as cardiac magnetic resonance imaging, we might have observed somewhat different results [21]. Although repeat cardiac biopsies are rarely performed, Mlejnek et al have recently provided data that such an approach may be safe and justified [22].…”

Effectiveness of myocarditis therapy depending on the diagnosis approach (with or without myocardial biopsy)

“…В то же время в элегантных работах чешской группы авторов неоднократно показано, что проведение необходимой ИСТ у больных с пересаженными сердцами, исходно инфицированными парвовирусом В19, не приводило ни к нарастанию вирусной нагрузки (напротив, она снижалась), ни к миокардиту, ни к клиническому ухудшению. Назначение ИСТ 8 пациентам с вируспозитивным миокардитом также не привело к нарастанию вирусной нагрузки, как и изолированная стандартная терапия ХСН у больных без ИСТ (в 1 случае из 5 отмечена даже полная элиминация парвовируса В19 из миокарда в группе ИСТ), в целом получено достоверное клиническое улучшение [10].…”

Twelve-month kinetics of circulating fibrosis-linked microRNAs (miR-21, miR-29, miR-30, and miR-133a) and the relationship with extracellular matrix fibrosis in dilated cardiomyopathy

“…Although repeat cardiac biopsies are rarely performed, Mlejnek et al . have recently provided data that such an approach may be safe and justified [ 22 ].…”