High prevalence of viral genomes and multiple viral infections in the myocardium of adults with "idiopathic" left ventricular dysfunction
High prevalence of viral genomes and multiple viral infections in the myocardium of adults with "idiopathic" left ventricular dysfunction
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DOI：
10.1161/01.cir.0000155616.07901.35
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发表时间：
2005-02-22
期刊：
影响因子：
37.8
通讯作者：
Schultheiss, HP
中科院分区：
文献类型：
--
作者：
Kühl, U;Pauschinger, M;Schultheiss, HP
背景-长期以来，肠道病毒被认为是急性病毒性心肌炎（MC）最常见的原因，并可能从MC转变为扩张型心肌病（DCM）。然而，最近的研究表明，MC患者中也经常遇到其他病毒，这表明各种病毒种类的持续存在可能在MC向DCM的转变中发挥致病作用。本研究的目的是通过使用聚合酶链反应（PCR）来筛选来自“特发性”DCM患者的肌内膜活检（EMB）中病毒基因组的存在，以评估可能参与疾病发病机制的心脏病毒感染的频率。（左心室射血分数中位数：35.0%;范围：9%-59%）。应用PCR和反转录- PCR方法检测肠道病毒（EV）、腺病毒（ADV）、人巨细胞病毒（HCMV）、单纯疱疹病毒（EBV）、人疱疹病毒6型（HHV-6）、细小病毒B19（PVB 19）、甲型和B型流感病毒的基因组序列。通过组织学和免疫组织化学分析评估心肌炎症。从165个EMB中可扩增出病毒基因组（67.4%）的245名DCM患者：EV = 23例（9.4%），ADV = 4例（1.6%），PVB 19 = 126例（51.4%），HHV-6 = 53例（21.6%），EBV = 5例（2.0%），HCMV = 2例（0.8%），其中多重感染n = 45例（27.3%）。根据达拉斯分类，所有病例均不存在活动性或临界性心肌炎。淋巴细胞和巨噬细胞浸润没有显着差异，在病毒阳性与病毒阴性patients.Conclusions -病毒基因组经常检测到收缩期左心室功能不全患者的心肌细胞。我们的数据表明，心肌持续存在的各种病毒，往往表现为多重感染，可能在DCM的发病机制中发挥作用，远远超过迄今为止的怀疑。
Background - For a long time, enteroviruses have been considered to be the most common cause of acute viral myocarditis (MC), with possible transition from MC to dilated cardiomyopathy (DCM). Recent investigations have shown, however, that other viruses are also frequently encountered in MC patients, suggesting that persistence of various virus species may play a pathogenic role in the transition from MC to DCM. The purpose of this study was to screen endomyocardial biopsies (EMBs) from patients with "idiopathic" DCM for the presence of viral genomes by using polymerase chain reaction (PCR) to assess the frequency of cardiac viral infections that may be involved in the pathogenesis of the disease.Methods and Results - EMBs were obtained for PCR analysis from 245 consecutive patients (median left ventricular ejection fraction, 35.0%; range, 9% to 59%). PCR and reverse transcription - PCR were performed to detect the genomic sequences of enterovirus (EV), adenovirus (ADV), human cytomegalovirus (HCMV), herpes simplex virus, Epstein-Barr virus (EBV), human herpesvirus 6 (HHV-6), parvovirus B19 (PVB19), and influenza A and B viruses. Myocardial inflammation was assessed by histological and immunohistological analyses. Viral genomes could be amplified from EMBs of 165 (67.4%) of the 245 DCM patients: EV = 23 (9.4%), ADV = 4 (1.6%), PVB19 = 126 (51.4%), HHV-6 = 53 (21.6%), EBV = 5 (2.0%), HCMV = 2 (0.8%), including n = 45 cases (27.3%) with multiple infections. Active or borderline myocarditis according to the Dallas classification did not exist in any case. Lymphocyte and macrophage infiltrates were not significantly different in virus-positive versus virus-negative patients.Conclusions - Viral genomes were frequently detected in EMBs of patients with systolic left ventricular dysfunction. Our data suggest that myocardial persistence of various viruses, often presenting as multiple infections, may play a role in the pathogenesis of DCM far more frequently than suspected so far.