Circulation, Vol 90, 330-339, Copyright © 1994 by American Heart Association
AB Martin, S Webber, FJ Fricker, R Jaffe, G Demmler, D Kearney, YH Zhang, J Bodurtha, B Gelb and J Ni
BACKGROUND: The diagnosis of viral myocarditis remains difficult and
generally depends on clinical and histological criteria. Viral cultures and
serology are often unrewarding, with low yields. The purpose of this study
was to analyze the usefulness of polymerase chain reaction (PCR) in the
rapid diagnosis of acute myocarditis in children. METHODS AND RESULTS: PCR
was used to analyze 38 myocardial tissue samples from 34 patients with
suspected acute viral myocarditis and 17 control patients with congenital
heart disease (14) or hypertrophic cardiomyopathy (3). Myocardial samples
were obtained at the time of right ventricular biopsy (13 samples), from
explanted hearts (18 samples) at transplantation, and from cardiac autopsy
specimens (24 samples) and were evaluated for the presence of enterovirus,
cytomegalovirus (CMV), adenovirus, and herpes simplex virus (HSV) using PCR
primers designed to consensus and unique sequences of these viral genomes.
Blood also was obtained at the time of biopsy (11) or transplant (18). In
26 of 38 myocardial samples (68%), viral genome was detected by PCR (15
adenoviral, 8 enteroviral, 2 HSV, 1 CMV), whereas all control myocardial
samples and blood samples were negative. Four patients had positive viral
cultures, and these matched the PCR findings. Disagreement with
histopathology occurred in 13 of 26 PCR- positive specimens, usually
associated with adenovirus. CONCLUSIONS: PCR offers a rapid, sensitive
diagnostic method for myocardial viral infection. While enterovirus is an
important etiological agent, adenovirus was more prevalent in this series
and should be evaluated when etiology is sought. PCR used in conjunction
with standard endomyocardial biopsy appears to enhance the likelihood of
detecting viral genome in the myocardium of patients with clinical evidence
of myocarditis.
ARTICLES
Acute myocarditis. Rapid diagnosis by PCR in children
Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Department of Pediatrics, Baylor College of Medicine, Houston 77030.
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