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Absence of viral nucleic acids in early and late dilated cardiomyopathy
1Department of Cardiological Sciences, St George's Hospital Medical School, London SW17 0RE, UK.
Insights
Viral infection does not appear to trigger dilated cardiomyopathy in genetically susceptible individuals. Studies found no evidence of myocardial viral infection in early-stage disease patients with a family history.
Area of Science:
- Cardiology
- Virology
- Genetics
Background:
- Dilated cardiomyopathy (DCM) can have genetic predispositions.
- The role of viral infections as a trigger in DCM development remains unclear.
- Investigating early-stage DCM in genetically predisposed individuals is crucial.
Purpose of the Study:
- To determine if viral infections trigger DCM in genetically predisposed individuals.
- To assess for viral nucleic acids in the myocardium of at-risk relatives.
Main Methods:
- Nested polymerase chain reaction (nPCR) was used to detect enteroviral, adenoviral, and cytomegaloviral nucleic acids.
- Myocardial tissue was analyzed from asymptomatic relatives with early echocardiographic abnormalities, explanted hearts from end-stage DCM patients, and controls.
- Positive controls included myocardial tissue from fatal coxsackie myocarditis cases.
Main Results:
- No viral nucleic acids were detected in the myocardium of relatives with suspected early DCM or in end-stage DCM patients compared to controls.
- Viral nucleic acids were only detected in the positive control group (coxsackie myocarditis).
- Assays demonstrated high sensitivity and reproducibility.
Conclusions:
- Myocardial viral infection is not detectable in individuals with suspected early-stage DCM and a family history.
- There is no evidence supporting viral infection as a trigger factor for initiating DCM in this population.
- Further research may explore other potential etiological factors for DCM.
Objective:
To investigate whether viral infection acts as a trigger factor for the development of dilated cardiomyopathy in genetically predisposed individuals with a family history of disease.
Setting:
Patients attending the cardiomyopathy unit in a cardiac tertiary referral centre.
Design:
Nested polymerase chain reaction (nPCR) was used to determine whether enteroviral, adenoviral, or cytomegaloviral nucleic acids were detectable in the myocardium of 19 asymptomatic relatives of patients with dilated cardiomyopathy; all these relatives had echocardiographic abnormalities thought to represent early disease. Explanted hearts from patients with end stage dilated cardiomyopathy were also studied and were compared with 25 controls (ischaemic heart disease (21), valvar heart disease (2), hypertrophic cardiomyopathy (1), restrictive cardiomyopathy (1)). Myocardial tissue from two fatal cases of culture positive coxsackie myocarditis was used as a positive control.
Results:
No viral nucleic acid was detected in any group other than in those with myocarditis. Spiking of random wells with purified recombinant viral nucleic acids confirmed the sensitivity and reproducibility of the assays.
Conclusions:
Myocardial viral infection is not detectable in relatives of patients with dilated cardiomyopathy who are suspected of having early disease. There is no evidence that viruses act as a trigger factor for initiating the dilated cardiomyopathy in these patients.
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