Department of Cardiology, CARIM, Maastricht University Medical Centre, the Netherlands.
Eur J Heart Fail. 2016 Dec;18(12):1430-1441. doi: 10.1002/ejhf.665. Epub 2016 Oct 17.
Over the last decade, parvovirus B19 (B19V) has frequently been linked to the pathogenesis of myocarditis (MC) and its progression towards dilated cardiomyopathy (DCM). The exact role of the presence of B19V and its load remains controversial, as this virus is also found in the heart of healthy subjects. Moreover, the prognostic relevance of B19V prevalence in endomyocardial biopsies still remains unclear. As a result, it is unclear whether the presence of B19V should be treated. This review provides an overview of recent literature investigating the presence of B19V and its pathophysiological relevance in MC and DCM, as well as in normal hearts. In brief, no difference in B19V prevalence is observed between MC/DCM and healthy control hearts. Therefore, the question remains open whether and how cardiac B19V may be of pathogenetic importance. Findings suggest that B19V is aetiologically relevant either in the presence of other cardiotropic viruses, or when B19V load is high and/or actively replicating, which both may maintain myocardial (low-grade) inflammation. Therefore, future studies should focus on the prognostic relevance of the viral load, replicative status and virus co-infections. In addition, the immunogenetic background of MC/DCM patients that makes them susceptible to develop heart failure upon presence of B19V should be more thoroughly investigated.
在过去的十年中，细小病毒 B19（B19V）频繁与心肌炎（MC）的发病机制及其向扩张型心肌病（DCM）的进展相关联。该病毒的存在及其载量的确切作用仍存在争议，因为在健康受试者的心脏中也发现了这种病毒。此外，心肌活检中 B19V 流行率的预后相关性仍不清楚。因此，尚不清楚是否应治疗 B19V 的存在。本综述概述了最近研究 B19V 存在及其在 MC 和 DCM 以及正常心脏中的病理生理相关性的文献。简而言之，在 MC/DCM 和健康对照组心脏之间，B19V 的流行率没有差异。因此，关于心脏 B19V 是否具有发病机制重要性以及如何具有发病机制重要性的问题仍然存在。研究结果表明，B19V 在存在其他心肌病毒时具有病因学相关性，或者当 B19V 载量高且/或正在积极复制时，这两者都可能维持心肌（低度）炎症。因此，未来的研究应集中在病毒载量、复制状态和病毒合并感染的预后相关性上。此外，应更深入地研究使 MC/DCM 患者易受 B19V 存在影响而发展为心力衰竭的免疫遗传背景。
