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Correspondence Letters to the Editor must not exceed 400 words in length and must be limited to three authors and five references. They should not have tables or figures and should relate solely to an article published in Circulation within the preceding 12 weeks. Authors of letters selected for publication will receive prepublication proofs, and authors of the article cited in the letter will be invited to reply. Replies must be signed by all authors listed in the original publication. Please submit three typewritten, double-spaced copies of the letter to Herbert L. Fred, MD, 噦 the Circulation Editorial Office. Letters will not be returned. Parvovirus B19 Genome in Endomyocardial Biopsy Specimen Downloaded from http://circ.ahajournals.org/ by guest on June 17, 2017 of patients with dilated cardiomyopathy and 8% of patients with perimyocarditis. These findings underline the role of PVB19 in the etiology of inflammatory heart disease, which in early stages may mimic acute myocardial infarction, as seen regularly in pericardial involvement in our patients. Frequency and clinical importance of PVB19 infection of the myocardium may be underestimated. Therefore, we suggest that routine detection of PVB19 genome by polymerase chain reaction from endomyocardial biopsies should be added to the standard clinical, molecular-biological, and immunohistochemical investigations in patients with suspected inflammatory heart disease, in order to establish a definite, rapid diagnosis and to examine pericarditis and effusion that by ECG may mimic myocardial infarction. To the Editor: A variety of cardiotropic viruses have been identified in the past to elicit myocarditis1 but rarely with parvovirus B19 (PVB19) as a causative agent in children and adolescents.2 However, PVB19 recently has emerged as another potential pathogen in adult patients with inflammatory heart disease.3 In the August 28, 2003, issue of Circulation, Kühl et al4 reported the association of PVB19 genome in endomyocardial biopsies in the clinical setting of acute myocardial infarction. Follow-up of a subgroup of PVB19-positive patients revealed that viral persistence may be associated with progression of left ventricular dysfunction. In a much larger cohort of 110 consecutive patients with suspected inflammatory heart disease, prevalence of PVB19, Coxsackievirus (CVB), and adenovirus (Ad2) genome was assessed by polymerase chain reaction, immunohistochemistry, and histopathology of endomyocardial biopsies.5 For control, biopsies of patients with arterial hypertension were studied. We have extended the number of investigated patients over a period of 3 years, including 208 individuals before and after therapy, where we confirmed the prevalence of PVB19 genome in endomyocardial biopsies to be highest in patients with inflammatory cardiomyopathy (23%) and in patients with myocarditis (19%). In patients with dilated cardiomyopathy and perimyocarditis, prevalence was 23% and 16%, respectively. In contrast, patients with resolved myocarditis had no detectable endomyocardial PVB19 genome, and in patients without inflammation/ dilatation and in controls, prevalence was 4% and 7%, respectively. Except for PVB19, CVB RNA was the most frequently detected viral genome. In patients with myocarditis, 8% were found to be positive for CVB RNA in endomyocardial biopsy and 5.5% were found to be positive for CVB RNA in peripheral blood. Ad2 DNA was found in myocardial tissue specimen in 5% Sabine Pankuweit, PhD Steffen Lamparter, MD Michael Schoppet, MD Bernhard Maisch, MD Department of Internal Medicine–Cardiology Philipps-University Marburg Baldinger Strasse 35043 Marburg, Germany [email protected] 1. Feldman AM, McNamara D. Myocarditis. N Engl J Med. 2000;343: 1388 –1398. 2. Murry CE, Jerome KR, Reichenbach DD. Fatal parvovirus myocarditis in a 5-year-old girl. Hum Pathol. 2001;32:342–345. 3. Lamparter S, Schoppet M, Pankuweit S, et al. Acute parvovirus B19 infection associated with myocarditis in an immunocompetent adult. Hum Pathol. 2003;34:725–728. 4. Kühl U, Pauschinger M, Bock T, et al. Parvovirus B19 infection mimicking acute myocardial infarction. Circulation. 2003;108:945–950. 5. Pankuweit S, Baandrup U, Moll R, et al. Prevalence of parvovirus B 19 genome in endomyocardial biopsy specimen. Hum Pathol. 2003;34: 80 – 86. 1 Parvovirus B19 Genome in Endomyocardial Biopsy Specimen Sabine Pankuweit, Steffen Lamparter, Michael Schoppet and Bernhard Maisch Circulation. 2004;109:e179 doi: 10.1161/01.CIR.0000124881.00415.59 Downloaded from http://circ.ahajournals.org/ by guest on June 17, 2017 Circulation is published by the American Heart Association, 7272 Greenville Avenue, Dallas, TX 75231 Copyright © 2004 American Heart Association, Inc. All rights reserved. Print ISSN: 0009-7322. Online ISSN: 1524-4539 The online version of this article, along with updated information and services, is located on the World Wide Web at: http://circ.ahajournals.org/content/109/14/e179 Permissions: Requests for permissions to reproduce figures, tables, or portions of articles originally published in Circulation can be obtained via RightsLink, a service of the Copyright Clearance Center, not the Editorial Office. Once the online version of the published article for which permission is being requested is located, click Request Permissions in the middle column of the Web page under Services. Further information about this process is available in the Permissions and Rights Question and Answer document. Reprints: Information about reprints can be found online at: http://www.lww.com/reprints Subscriptions: Information about subscribing to Circulation is online at: http://circ.ahajournals.org//subscriptions/