Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA.
Circ Heart Fail. 2011 Jan;4(1):71-8. doi: 10.1161/CIRCHEARTFAILURE.110.958249. Epub 2010 Nov 19.
Multiple viruses have been isolated from the heart, but their significance remains controversial. We sought to determine the prevalence of cardiotropic viruses in endomyocardial biopsy (EMB) samples from adult patients with heart failure (HF) and to define the clinicopathologic profile of patients exhibiting viral positivity.
EMB from 100 patients (median ejection fraction, 30%; interquartile range [IQR], 20% to 45%) presenting for cardiomyopathy evaluation (median symptom duration, 5 months; IQR, 1 to 13 months) were analyzed by polymerase chain reaction for adenovirus, cytomegalovirus, enteroviruses, Epstein-Barr virus, and parvovirus B19. Each isolate was sequenced, and viral load was determined. Parvovirus B19 was the only virus detected in EMB samples (12% of subjects). No patient had antiparvovirus IgM antibodies, but all had IgG antibodies, suggesting viral persistence. The clinical presentation of parvovirus-positive patients was markedly heterogeneous with both acute and chronic HF, variable ventricular function, and ischemic cardiomyopathy. No patient met Dallas histopathologic criteria for active or borderline myocarditis. Two patients with a positive cardiac MRI and presumed "parvomyocarditis" had similar viral loads to autopsy controls without heart disease. The oldest parvovirus-positive patients were positive for genotype 2, suggesting lifelong persistence in the myocardium.
Parvovirus B19 was the only virus isolated from EMB samples in this series of adult patients with HF from the United States. Positivity was associated with a wide array of clinical presentations and HF phenotypes. Our studies do not support a causative role for parvovirus B19 persistence in HF and, therefore, advocate against the use of antiviral therapy for these patients.
已从心脏中分离出多种病毒，但它们的意义仍存在争议。我们旨在确定患有心力衰竭（HF）的成年患者的心肌活检（EMB）样本中心病毒的流行率，并确定表现出病毒阳性的患者的临床病理特征。
通过聚合酶链反应对 100 名患者（中位射血分数为 30％；四分位距 [IQR]为 20％至 45％）的 EMB 进行分析，这些患者因心肌病评估而就诊（中位症状持续时间为 5 个月； IQR，1 至 13 个月），用于检测腺病毒，巨细胞病毒，肠道病毒，Epstein-Barr 病毒和细小病毒 B19。对每种分离株进行测序，并确定病毒载量。细小病毒 B19是唯一在 EMB 样本中检测到的病毒（占研究对象的 12％）。没有患者具有抗细小病毒 IgM 抗体，但所有人都具有 IgG 抗体，表明存在病毒持续存在。细小病毒阳性患者的临床表现明显不同，包括急性和慢性 HF，不同的心室功能和缺血性心肌病。没有患者符合达拉斯组织病理学标准的活动性或交界性心肌炎。两名心脏 MRI 阳性且推测为“细小病毒心肌炎”的患者与没有心脏病的尸检对照的病毒载量相似。最年长的细小病毒阳性患者的基因型为 2，表明其在心肌中的终生持续存在。
在该系列来自美国的 HF 成年患者中，细小病毒 B19 是唯一从 EMB 样本中分离出的病毒。阳性与广泛的临床表现和 HF 表型有关。我们的研究不支持细小病毒 B19 持续存在与 HF 之间的因果关系，因此不建议对这些患者使用抗病毒治疗。
