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Frequent detection of parvovirus B19 genome in the myocardium of adult patients with idiopathic dilated cardiomyopathy

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Abstract

Aside from enteroviruses and other viruses, e.g., adenoviruses, which are known to be associated with idiopathic dilated cardiomyopathy (IDC), a cardiac tropism is also attributed to parvovirus B19 (PVB19). The purpose of the present study was to determine the prevalence of enterovirus, adenovirus and PVB19 genomes in the myocardium of adult patients with IDC and to analyze the significance of PVB19 with regard to the course of the disease, as compared to the other cardiotropic viruses. In 52 adult patients with IDC and 10 control patients with normal left ventricular ejection fraction (≥55%) undergoing coronary artery bypass surgery, myocardial tissue samples were investigated for enteroviral RNA using polymerase chain reaction (PCR) and Southern blot hybridization of the PCR product. Specific nested PCR was used to assess the prevalence of adenovirus and PVB19 DNA, in addition to sequencing of the latter. The clinical and echocardiographic course of the disease was followed for a mean (± SD) period of 21.1±9.5 months. Fourteen of the 52 patients (27%) were enterovirus-positive, 2/52 (4%) patients were adenovirus-positive, 14/52 (27%) patients were PVB19-positive, 8/52 (15%) patients were enterovirus plus PVB19-positive, and in 14/52 (27%) patients no viral genomes were found. Six patients died during the follow-up period, without any significant difference between the patient groups: 1/14 (7%) in the enterovirus-positive, 0/2 (0%) in the adenovirus-positive, 2/14 (14%) in the PVB19-positive, 1/8 (12.5%) in the enterovirus plus PVB19-positive, and 2/14 (14%) in the virus-negative group. PVB19 genome was found in 4 of the 10 (40%) control patients, but no enterovirus or adenovirus genomes were detected in these patients. In conclusion, in the myocardium of patients with IDC, PVB19 is detectable as frequently as enteroviral genome. PVB19-positive patients with IDC have a rather favorable prognosis and do not differ significantly from the other virus-positive or virus-negative patient groups with respect to survival. Finally, the pathogenetic and prognostic significance of PVB19 in IDC still remains unclear.

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Acknowledgements

We are grateful to Roland Zell, PhD (Institute of Virology and Antiviral Therapy, Friedrich-Schiller-University, Jena, Germany) for performing the sequence analysis of 11 positive PVB19 isolates. We are indebted to Prof. Gerhard Mall, MD (Department of Pathology, Städtische Kliniken Darmstadt, Germany) for histological and immunohistological investigations of the cardiac tissue samples and for assessing the myocyte diameter and the volume fraction of interstitial fibrosis. Furthermore, we are grateful to Prof. Thorsten Wahlers, MD and colleagues (Department of Cardiothoracic and Vascular Surgery, Friedrich-Schiller-University, Jena, Germany) for providing myocardial tissue samples from patients undergoing coronary artery bypass surgery. Finally, we thank Mrs. Birgit Lotze for her help in the preparation of the manuscript.

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Lotze, U., Egerer, R., Tresselt, C. et al. Frequent detection of parvovirus B19 genome in the myocardium of adult patients with idiopathic dilated cardiomyopathy. Med Microbiol Immunol 193, 75–82 (2004). https://doi.org/10.1007/s00430-003-0211-0

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