Download Parvovirus B19 Genome in Endomyocardial Biopsy Specimen

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/