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Circulation, Vol 89, 2582-2589, Copyright © 1994 by American Heart Association
HJ Why, BT Meany, PJ Richardson, EG Olsen, NE Bowles, L Cunningham, CA Freeke and LC Archard
BACKGROUND: Enteroviral RNA sequences have been demonstrated in the
myocardium of patients with myocarditis or dilated cardiomyopathy from
presentation to end-stage disease. The prognosis of heart muscle disease
has not previously been evaluated in relation to the detection of
enterovirus in myocardial biopsy tissue. METHODS AND RESULTS: We studied
123 consecutive patients with heart muscle disease prospectively. Multiple
endomyocardial biopsy samples taken from all patients during diagnostic
cardiac catheterization were classified histologically and were examined
for enteroviral RNA by use of an enterovirus group-specific hybridization
probe. Three enterovirus- negative patients with cardiac amyloidosis were
excluded from subsequent analysis. Enteroviral RNA sequences were
detectable in 41 (34%) of the remaining 120 patients (group A), while 79
(66%) had no virus detected (group B). The groups did not differ
significantly in age, sex, symptomatic presentation, or hemodynamic
characteristics; duration of symptoms was significantly shorter in group A
(7.8 +/- 9.6 versus 14.9 +/- 19.0 months, P < .05). At follow-up (mean,
25 months; range, 11 to 50 months), patients from group A had an increased
mortality compared with those in group B (25% versus 4%, respectively; P =
.02). Mortality was also statistically greater in patients with symptomatic
cardiac failure (P = .02), those with elevated left ventricular
end-diastolic pressures (P = .03), and those in New York Heart Association
functional classes III and IV (P = .05). Multivariate regression analysis,
however, showed that only the presence of enterovirus RNA and symptomatic
heart failure were of independent prognostic value. CONCLUSIONS: These data
demonstrate that the detection of enterovirus RNA in the myocardium of
patients with heart muscle disease at the time of initial investigation is
associated with an adverse prognosis and that the presence of enterovirus
RNA is an independent predictor of clinical outcome.
ARTICLES
Clinical and prognostic significance of detection of enteroviral RNA in the myocardium of patients with myocarditis or dilated cardiomyopathy
Cardiac Department, King's College Hospital, Denmark Hill, London, UK.
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