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CLINICAL STUDY

Detection of viruses in myocardial tissues by polymerase chain reaction

evidence of adenovirus as a common cause of myocarditis in children and adults

Neil E. Bowles, PhD^*, Jiyuan Ni, MD^*, Debra L. Kearney, MD^*, Matthias Pauschinger, MD, Heinz-Peter Schultheiss, MD, Robert McCarthy, MD^¶, Joshua Hare, MD, FACC, J. Timothy Bricker, MD, FACC^*, Karla R. Bowles, PhD^* and Jeffrey A. Towbin, MD, FACC^*||,*

^* Departments of Pediatrics, Houston, Texas, USA
Pathology, Houston, Texas, USA
^|| Molecular and Human Genetics, Houston, Texas, USA
^¶ Cardiovascular Sciences, Baylor College of Medicine, Houston, Texas, USA
Medical Clinic II, University Hospital Benjamin Franklin, Berlin, Germany
Department of Internal Medicine, Division of Cardiology, The Johns Hopkins Hospital, Baltimore, Maryland, USA

Manuscript received October 14, 2002; revised manuscript received February 24, 2003, accepted March 12, 2003.

^* Reprint requests and correspondence: Dr. Jeffrey A. Towbin, Department of Pediatrics (Cardiology), Baylor College of Medicine, 6621 Fannin, Room FC.430.09, Houston, Texas 77030, USA.
jtowbin{at}bcm.tmc.edu

OBJECTIVES: The purpose of this study was to analyze cardiac tissue and blood for viral genomes using polymerase chain reaction (PCR) to define the common viral etiologies of myocarditis by age group.

BACKGROUND: Enteroviruses are considered the most common cause of myocarditis at all ages. Diagnosis relies on viral cultures, serology, and cardiac histology, which lack sensitivity, as well as PCR. However, in many cases enteroviruses are not detected.

METHODS: Cardiac samples were obtained for PCR analysis from patients with myocarditis (n = 624) and dilated cardiomyopathy (DCM) (n = 149). Patients were analyzed by age group, including neonates (n = 116), infants (n = 191), toddlers (n = 87), children (n = 110), adolescents (n = 92), and adults (n = 177). After nucleic acids had been extracted from an endomyocardial biopsy, an explant, or autopsy samples, PCR and reverse transcription PCR were performed to detect the genomic sequences of enterovirus, adenovirus, cytomegalovirus (CMV), herpes simplex virus (HSV), Epstein-Barr virus (EBV), parvovirus, respiratory syncytial virus (RSV), and influenza A virus.

RESULTS: Viral genome was amplified (adenovirus = 142, enterovirus = 85, CMV = 18, parvovirus = 6, influenza A = 5, HSV = 5, EBV = 3, RSV = 1) from 239 (38%) of the 624 samples from myocarditis patients, including 26 patient samples in which dual infection was found. Virus was detected in 30 (20%) of 149 DCM patient samples; only adenovirus (n = 18) and enterovirus (n = 12) were detected.

CONCLUSIONS: Polymerase chain reaction identified adenovirus as the most common virus in the myocardium of children and adults with myocarditis and DCM. Although enteroviruses are also found in these patients, they appear to be a less common cause of myocarditis than adenovirus.

Abbreviations and Acronyms   CHF   congestive heart failure   CMV   cytomegalovirus   DCM   dilated cardiomyopathy   EBV   Epstein-Barr virus   EFE   endocardial fibroelastosis   EMB   endomyocardial biopsy   HSV   herpes simplex virus   LV   left ventricle/ventricular   OHT   orthotopic heart transplantation   PCR   polymerase chain reaction   RNA   ribonucleic acid   RSV   respiratory syncytial virus   RV   right ventricle/ventricular

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