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Viral persistence in the myocardium is associated with progressive cardiac dysfunction

Uwe Kühl1, Matthias Pauschinger, Bettina Seeberg

  • 1Charite, Universitätsmedizin Berlin, Campus Benjamin-Franklin, Medizinische Klinik II, Abteilung für Kardiologie und Pneumologie, Hindenburgdamm 30, 12200 Berlin, Germany. uwe.kuehl@charite.de

Circulation
|September 21, 2005
PubMed

Insights

Viral heart infections like enterovirus and parvovirus B19 can cause myocarditis. Spontaneous viral clearance improves heart function, while persistence worsens it, offering insights into viral cardiomyopathy progression.

Area of Science:

  • Cardiology
  • Virology
  • Pathology

Background:

  • Cardiotropic viral infections are implicated in myocarditis and dilated cardiomyopathy.
  • The natural progression of viral heart disease remains largely unknown.
  • Previous studies suggest adverse outcomes in dilated cardiomyopathy patients.

Purpose of the Study:

  • To investigate the natural course of viral heart disease using endomyocardial biopsies.
  • To determine the impact of viral clearance or persistence on left ventricular function.
  • To analyze the clearance rates of specific cardiotropic viruses in myocardial tissue.

Main Methods:

  • Analysis of 172 patients with biopsy-proven viral infections via endomyocardial biopsies (EMBs).
  • Reanalysis of EMBs and hemodynamic measurements after a median follow-up of 6.8 months.
  • Detection of viral genomic sequences using nested polymerase chain reaction (PCR) and reverse transcription-PCR.

Main Results:

  • Enterovirus (EV), adenovirus (ADV), parvovirus B19 (PVB19), and human herpesvirus 6 (HHV6) were detected in EMBs.
  • Spontaneous viral genome clearance occurred in 36.2% of patients with single infections.
  • Viral clearance correlated with improved left ventricular ejection fraction (LVEF), while persistence led to decreased LVEF.

Conclusions:

  • This study provides the first biopsy-based analysis of viral heart disease progression.
  • Viral persistence in the myocardium is linked to progressive LVEF impairment.
  • Spontaneous viral elimination is associated with significant recovery of LV function.
Abstract

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