eISSN: 1896-9151
ISSN: 1734-1922
Archives of Medical Science
Current issue Archive Manuscripts accepted About the journal Special issues Editorial board Abstracting and indexing Subscription Contact Instructions for authors
SCImago Journal & Country Rank
6/2018
vol. 14
 
Share:
Share:
more
 
 
abstract:
Basic research

Viral genome changes and the impact of viral genome persistence in myocardium of patients with inflammatory cardiomyopathy

Dalibor Mlejnek, Jan Krejci, Petr Hude, Eva Ozabalova, Vita Zampachova, Radka Stepanova, Iva Svobodová, Tomas Freiberger, Eva Nemcova, Lenka Spinarova

Arch Med Sci 2018; 14, 6: 1245–1253
Online publish date: 2018/10/23
View full text
Get citation
ENW
EndNote
BIB
JabRef, Mendeley
RIS
Papers, Reference Manager, RefWorks, Zotero
AMA
APA
Chicago
Harvard
MLA
Vancouver
 
Introduction
Viral infections are considered the most frequent cause of myocarditis and dilated cardiomyopathy (DCM).

Material and methods
We investigated the changes in viral presence and the impact of viral genome persistence in the myocardium on echocardiographic parameters, functional status and some laboratory parameters in a 6-month follow-up. Fifty-four patients with recent onset DCM, left ventricular ejection fraction < 40% and biopsy-proven myocarditis (> 14 mononuclear leukocytes/mm2 and/or > 7 T-lymphocytes/mm2) were enrolled. Polymerase chain reaction (PCR) was performed to detect pathogens in the myocardium. Patients were divided according to the administered therapy: standard heart failure medication (46 patients) and immunosuppressive therapy (8 patients).

Results
In the standard heart failure medication group viral clearance was observed in 13 patients and viral persistence in 24 patients in the follow-up period. Comparing both groups, there was no statistically significant difference – LVEF improvement of 12.0 ±11.4% vs. 18.3 ±12.6%, decrease in NYHA class of 0.7 ±0.7 vs. 1.0 ±0.7, decline in NT-proBNP of 1335 ±1933 ng/l vs. 1942 ±3242 ng/l and decrease in infiltrating leukocytes of 11.1 ±15.8 vs. 6.7 ±23.0 cells/mm2 and T-lymphocytes of 5.8 ±15.1 vs. 1.8 ±10.9 cells/mm2 (all p = NS). A decrease in PCR positive patients from 37 to 29 was observed. The number of PVB19 positive PCR findings decreased from 5 to 4 in patients with immunosuppressive therapy.

Conclusions
A decrease in the number of positive PCR findings in control endomyocardial biopsy was observed. Viral genome persistence was not associated with worse outcome in short-term follow-up.

keywords:

polymerase chain reaction, myocarditis, dilated cardiomyopathy, endomyocardial biopsy, inflammatory cardiomyopathy

references:
Kusiak A, Wiliński J, Wojciechowska W, et al. Echocardiographic assessment of right ventricular function in responders and non-responders to cardiac resynchronization therapy. Arch Med Sci 2015; 11: 736-42.
Stehlik J, Edwards LB, Kucheryavaya AY, et al. The Registry of the International Society for Heart and Lung Transplantation: twenty-seventh official adult heart transplant report--2010. J Heart Lung Transplant 2010; 29: 1089-103.
Cooper LT. The heat is off: immunosuppression for myocarditis revisited. Eur Heart J 2009; 30: 1936-9.
Krejci J, Poloczkova H, Hude P, et al. Impact of inflammatory infiltration and viral genome presence in myocardium on the changes of echocardiographic parameters. Cor et Vasa 2013; 4: e333-40.
Kühl U, Pauschinger M, Noutsias M, et al. High prevalence of viral genomes and multiple viral infections in the myocardium of adults with “idiopathic” left ventricular dysfunction. Circulation 2005; 111: 887-93.
Bruno VD, Duggan S, Capoun R, Ascione R. Methamphetamine-induced cardiomyopathy causing severe mitral valve regurgitation. Arch Med Sci 2014; 10: 630-1.
Huszno J, Badora A, Nowara E. The influence of steroid receptor status on the cardiotoxicity risk in HER2-positive breast cancer patients receiving trastuzumab. Arch Med Sci 2015; 11: 371-7.
Kindermann I, Kindermann M, Kandolf R, et al. Predictors of outcome in patients with suspected myocarditis. Circulation 2008; 118: 639-48.
Blauwet LA, Cooper LT. Myocarditis. Prog Cardiovasc Dis 2010; 52: 274-88.
Kuethe F, Lindner J, Matschke K, et al. Prevalence of parvovirus B19 and human bocavirus DNA in the heart of patients with no evidence of dilated cardiomyopathy or myocarditis. Clin Infect Dis 2009; 49: 1660-6.
Cooper LT. Myocarditis. N Engl J Med 2009; 360: 1526-38.
Dennert R, Crijns HJ, Heymans S. Acute viral myocarditis. Eur Heart J 2008; 29: 2073-82.
Kindermann I, Barth C, Mahfoud F, et al. Update on myocarditis. J Am Coll Cardiol 2012; 59: 779-92.
Caforio AL, Marcolongo R, Basso C, Iliceto S. Clinical presentation and diagnosis of myocarditis. Heart 2015; 101: 1332-44.
Lotze U, Egerer R, Glück B, et al. Low level myocardial parvovirus B19 persistence is a frequent finding in patients with heart disease but unrelated to ongoing myocardial injury. J Med Virol 2010; 82: 1449-57.
Caforio AL, Calabrese F, Angelini A, et al. A prospective study of biopsy-proven myocarditis: prognostic relevance of clinical and aetiopathogenetic features at diagnosis. Eur Heart J 2007; 28: 1326-33.
Kühl U, Lassner D, von Schlippenbach J, Poller W, Schultheiss HP. Interferon-beta improves survival in enterovirus-associated cardiomyopathy. J Am Coll Cardiol 2012; 60: 1295-6.
Kühl U, Pauschinger M, Seeberg B, et al. Viral persistence in the myocardium is associated with progressive cardiac dysfunction. Circulation 2005; 112: 1965-70.
McMurray JJ, Adamopoulos S, Anker SD, et al. ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC. Eur Heart J 2012; 33: 1787-847.
Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation 2013; 128: 1810-52.
Paleček T, Krejci J, Pecen L, et al. Czech Inflammatory Cardiomyopathy Immunosuppression Trial (CZECH-ICIT): randomized, multicentric study comparing the effect of two regimens of combined immunosuppressive therapy in the treatment of inflammatory cardiomyopathy: the aims and design of the trial. Cor et Vasa 2013; 6: e475-8.
Frustaci A, Russo MA, Chimenti C. Randomized study on the efficacy of immunosuppressive therapy in patients with virus-negative inflammatory cardiomyopathy: the TIMIC study. Eur Heart J 2009; 30: 1995-2002.
Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification. Eur J Echocardiogr 2006; 7: 79-108.
Bruder O, Wagner A, Lombardi M, et al. European Cardiovascular Magnetic Resonance (EuroCMR) registry: multi national results from 57 centers in 15 countries. J Cardiovasc Magn Reson 2013; 15: 9.
Friedrich MG, Sechtem U, Schulz-Menger J, et al. Cardiovascular magnetic resonance in myocarditis: a JACC white paper. J Am Coll Cardiol 2009; 53: 1475-87.
Lurz P, Eitel I, Adam J, et al. Diagnostic performance of CMR imaging compared with EMB in patients with suspected myocarditis. JACC Cardiovasc Imaging 2012; 5: 513-24.
Olimulder MA, van Es J, Galjee MA. The importance of cardiac MRI as a diagnostic tool in viral myocarditis-induced cardiomyopathy. Neth Heart J 2009; 17: 481-6.
Caforio AL, Pankuweit S, Arbustini E, et al. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J 2013; 34: 2636-48, 2648a-2648d.
Breinholt JP, Moulik M, Dreyer WJ, et al. Viral epidemiologic shift in inflammatory heart disease: the increasing involvement of parvovirus B19 in the myocardium of pediatric cardiac transplant patients. J Heart Lung Transplant 2010; 29: 739-46.
Maisch B, Pankuweit S. Current treatment options in (peri)myocarditis and inflammatory cardiomyopathy. Herz 2012; 37: 644-56.
Krejci J, Hude P, Poloczkova H, et al. Correlations of the changes in bioptic findings with echocardiographic, clinical and laboratory parameters in patients with inflammatory cardiomyopathy. Heart Vessels 2016; 31: 416-26.
Kühl U, Pauschinger M, Schwimmbeck PL, et al. Interferon-beta treatment eliminates cardiotropic viruses and improves left ventricular function in patients with myocardial persistence of viral genomes and left ventricular dysfunction. Circulation 2003; 107: 2793-8.
Wojnicz R, Nowalany-Kozielska E, Wojciechowska C, et al. Randomized, placebo-controlled study for immunosuppressive treatment of inflammatory dilated cardiomyopathy: two-year follow-up results. Circulation 2001; 104: 39-45.
Frustaci A, Chimenti C, Calabrese F, et al. Immunosuppressive therapy for active lymphocytic myocarditis. Virological and immunologic profile of responders versus nonresponders. Circulation 2003; 107: 857-86.
Bock CT, Klingel K, Kandolf R. Human parvovirus B19-associated myocarditis. N Engl J Med 2010; 362: 1248-9.
Bock CT, Düchting A, Utta F, et al. Molecular phenotypes of human parvovirus B19 in patients with myocarditis. World J Cardiol 2014; 6: 183-95.
FEATURED PRODUCTS
Quick links
© 2018 Termedia Sp. z o.o. All rights reserved.
Developed by Bentus.
PayU - płatności internetowe