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Elevation of ALT to AST ratio in patients with enteroviral myocarditis
T Kanda1, I Kobayashi, T Suzuki
1Department of Laboratory Medicine, Gunma University School of Medicine, Maebashi, Japan.
Insights
Enteroviral peri-myocarditis in adults can affect the liver. A high ALT/AST ratio frequently indicates hepatic involvement, suggesting this is more common than previously thought.
Area of Science:
- Cardiology
- Hepatology
- Infectious Diseases
Background:
- Enteroviral myocarditis is generally considered benign in adults.
- Physicians may overlook non-cardiac viral involvement due to incomplete data.
- Subtle hepatic involvement in enteroviral peri-myocarditis is often unrecognized.
Purpose of the Study:
- To investigate hepatic involvement in adult enteroviral peri-myocarditis.
- To compare hepatic involvement markers with congestive heart failure conditions.
- To assess the diagnostic utility of liver enzyme ratios in viral heart conditions.
Main Methods:
- Analysis of 18 patients with enteroviral myocarditis or pericarditis.
- Serological testing for coxsackie and echoviruses.
- Diagnosis of hepatic involvement based on elevated ALT and AST levels, with ALT/AST ratio > 1.0.
Main Results:
- Elevated ALT/AST ratio (>1.0) was observed in 72% of peri-myocarditis patients.
- This ratio was significantly higher compared to acute myocardial infarction (0%) and idiopathic dilated cardiomyopathy (3%).
- Coxsackie viruses were identified in 11 patients, echoviruses in six.
Conclusions:
- Hepatic involvement is common in adult enteroviral peri-myocarditis.
- The ALT/AST ratio can aid in diagnosing liver involvement.
- Recognizing hepatic involvement may improve diagnostic accuracy and treatment strategies for viral myocarditis.
Abstract:
Enteroviral myocarditis is often a relatively benign condition in adults. Physicians, therefore, may not always record detailed clinical and laboratory data in such patients. As such, they may not recognize viral involvement in organs beyond the heart. The purpose of this study was to examine the hepatic involvement of enteroviral peri-myocarditis and to compare the other diseases with congestive heart failure. We analyzed 18 patients (ages 15-64) who were diagnosed as having enteroviral myocarditis (n = 16) or pericarditis (n = 2). Serology was positive for coxsackie viruses in 11 patients and echoviruses in six patients. A diagnosis of hepatic involvement was made by the following laboratory data: rising levels of alanine amino transferase (ALT), aspartate amino transferase (AST) and exceeded serum ALT compared with AST levels. A ratio of ALT/AST more than 1.0 was greatly frequent in patients with peri-myocarditis (72%; 13/18) compared with acute myocardial infarction (0%; 0/10) and idiopathic dilated cardiomyopathy (3%; 3/10). In summary, hepatic involvement in the setting of acute enteroviral peri-myocarditis may be considerably more common in adults than previously suspected. The recognition of hepatic involvement in association with enteroviral peri-myocarditis may allow improvement of diagnostic sensitivity and alter approaches to treatments of acute viral myocarditis.