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CLINICAL STUDY: CARDIOMYOPATHY

Evaluation of viral infection in the myocardium of patients with idiopathic dilated cardiomyopathy

^a Third Division, Department of Internal Medicine, Osaka Medical College, Takatsuki, Japan
^b Central Clinical Laboratory, Osaka Medical College, Takatsuki, Japan
^c Shonan Kamakura General Hospital, Heart Center, Kamakura, Japan

Manuscript received January 13, 2000; revised manuscript received May 4, 2000, accepted June 28, 2000.

Reprint requests and correspondence: Dr. Shigekazu Fujioka, Third Division, Department of Internal Medicine, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, 569-8686 Japan

OBJECTIVES

The aim of this study was to evaluate the viral etiology of idiopathic dilated cardiomyopathy (DCM).

BACKGROUND

The demonstration of enteroviral genome in hearts with DCM has reinforced the importance of enteroviruses in the pathogenesis of DCM. However, there is uncertainty about the character and activity of enteroviruses detected in the myocardium. Recently, the association of hepatitis C virus or adenovirus with DCM has been reported.

METHODS

Myocardial specimens from 26 patients with idiopathic DCM, which were obtained at partial left ventriculectomy (PLV), were examined virologically. Strand-specific detection of enteroviral RNA was performed to differentiate active viral replication from latent persistence. Polymerase chain reaction was used to detect genomic sequences of hepatitis C virus, adenovirus, cytomegalovirus, influenza viruses, mumps virus, herpes simplex viruses, varicella-zoster virus and Epstein-Barr virus.

RESULTS

Plus-strand enteroviral RNA was detected in 9 (35%) of the 26 patients. Minus-strand enteroviral RNA was determined in seven (78%) of these nine plus-strand RNA-positive patients. Sequence analysis revealed that the enteroviruses detected were coxsackie B viruses, such as coxsackievirus B3 and B4. However, genetic material from other viruses was not detected. Six (86%) of seven minus-strand enteroviral RNA-positive patients died of cardiac insufficiency within the first six months after PLV.

CONCLUSIONS

Coxsackie B viruses were seen in hearts with idiopathic DCM. Active viral RNA replication appeared to be present in a significant proportion of these cases. Minus-strand coxsackieviral RNA in the myocardium can be a marker for poor clinical outcome after PLV. There was no evidence of persistent infection by other viruses in hearts with DCM.

Abbreviations and Acronyms   cDNA = complementary DNA   DCM = dilated cardiomyopathy   N-PCR = nested polymerase chain reaction   NYHA = New York Heart Association   PCR = polymerase chain reaction   PLV = partial left ventriculectomy   RT-PCR = reverse transcription polymerase chain reaction

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