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Prevalence and prognostic relevance of myocardial inflammation and cardiotropic viruses in non-ischemic dilated cardiomyopathy

Ieva Kažukauskienė, Vaida Baltrūnienė, Artūras Jakubauskas, Edvardas Žurauskas, Vytė Valerija Maneikienė, Dainius Daunoravičius, Jelena Čelutkienė, Kęstutis Ručinskas, Virginija Grabauskienė
DOI: 10.5603/CJ.a2020.0088
·
Pubmed: 32567670

open access

Ahead of print
Original articles
Published online: 2020-06-17

Abstract

Background: Non-ischemic dilated cardiomyopathy (DCM) is a heterogeneous disease with a spectrum of etiological factors. However, subsets of the disease are not well-characterized with respect to these factors. The aim of this study was to evaluate the prevalence of myocardial inflammation and cardiotropic viruses in DCM patients and their impact on clinical outcome.

Methods: Fifty-seven patients with DCM underwent endomyocardial biopsy between 2010 and 2013. Biopsies were analyzed by polymerase chain reaction (PCR) for the presence of cardiotropic viruses, and inflammatory cell infiltration was assessed by immunohistochemistry. During a 5-year follow-up, 27 (47%) patients reached the primary composite outcome measure: heart transplantation, left ventricle assist device implantation or cardiovascular-related death.

Results: rvovirus B19 and human herpesvirus type-6. Four specific sub-groups were distinguished by PCR and immunohistochemistry: virus-positive (chronic) myocarditis, autoreactive inflammatory DCM, viral DCM, non-inflammatory DCM. The presence of a viral genome in myocardium or diagnosis of inflammatory DCM did not predict the outcome of composite outcome measures (p > 0.05). However, univariate Cox regression and survival function estimation revealed an association between inflammation by a high number of T-cells and poor prognosis.

Conclusions: This study has shown that two markers — cardiotropic viruses and myocardial inflammation — are prevalent among DCM patients. They are also helpful in identifying sub-groups of DCM. An increased number of T-lymphocytes in the myocardium is a predictor of poor mid-term and long‐term prognosis.

Abstract

Background: Non-ischemic dilated cardiomyopathy (DCM) is a heterogeneous disease with a spectrum of etiological factors. However, subsets of the disease are not well-characterized with respect to these factors. The aim of this study was to evaluate the prevalence of myocardial inflammation and cardiotropic viruses in DCM patients and their impact on clinical outcome.

Methods: Fifty-seven patients with DCM underwent endomyocardial biopsy between 2010 and 2013. Biopsies were analyzed by polymerase chain reaction (PCR) for the presence of cardiotropic viruses, and inflammatory cell infiltration was assessed by immunohistochemistry. During a 5-year follow-up, 27 (47%) patients reached the primary composite outcome measure: heart transplantation, left ventricle assist device implantation or cardiovascular-related death.

Results: rvovirus B19 and human herpesvirus type-6. Four specific sub-groups were distinguished by PCR and immunohistochemistry: virus-positive (chronic) myocarditis, autoreactive inflammatory DCM, viral DCM, non-inflammatory DCM. The presence of a viral genome in myocardium or diagnosis of inflammatory DCM did not predict the outcome of composite outcome measures (p > 0.05). However, univariate Cox regression and survival function estimation revealed an association between inflammation by a high number of T-cells and poor prognosis.

Conclusions: This study has shown that two markers — cardiotropic viruses and myocardial inflammation — are prevalent among DCM patients. They are also helpful in identifying sub-groups of DCM. An increased number of T-lymphocytes in the myocardium is a predictor of poor mid-term and long‐term prognosis.

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Keywords

dilated cardiomyopathy, chronic heart failure, myocardial inflammation, viruses, prognosis

About this article
Title

Prevalence and prognostic relevance of myocardial inflammation and cardiotropic viruses in non-ischemic dilated cardiomyopathy

Journal

Cardiology Journal

Issue

Ahead of print

Article type

Original Article

Published online

2020-06-17

DOI

10.5603/CJ.a2020.0088

Pubmed

32567670

Keywords

dilated cardiomyopathy
chronic heart failure
myocardial inflammation
viruses
prognosis

Authors

Ieva Kažukauskienė
Vaida Baltrūnienė
Artūras Jakubauskas
Edvardas Žurauskas
Vytė Valerija Maneikienė
Dainius Daunoravičius
Jelena Čelutkienė
Kęstutis Ručinskas
Virginija Grabauskienė

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