Abstract 2409: Parvovirus B19 and Cardiomyopathy - The New Coxsackievirus
Enteroviruses such as coxsackievirus have been long considered a common cause of viral myocarditis. More recently multiple cardiotropic viruses have been isolated from endomyocardial biopsies (EMBx) from patients with myocarditis and idiopathic ventricular dysfunction. To determine the prevalence of viral genomic material in EMBx from adult heart failure patients. EMBx were obtained from 100 consecutive patients (median ejection fraction 20%, range 15– 65%) presenting for cardiomyopathy evaluation (median duration of symptoms 6mos, range 2d-20yrs). Frozen EMBx were evaluated using PCR and RT-PCR for cardiotropic viruses using primers specific for adenovirus, cytomegalovirus, enteroviruses, Epstein-Barr virus, and parvovirus B19 (PVB19). Positive human DNA/RNA controls were performed. Formalin preserved EMBx were evaluated by light microscopy for the presence of myocarditis. PVB19 was the only cardiotropic virus isolated from EMBx tissue (n = 12). Viral sequencing revealed different strains of PVB19 in each subject. No PVB19 positive subject had anti-parvovirus IgM, but all had circulating IgG, suggesting chronic infection. No subject with a PVB19 positive EMBx had evidence of active or borderline myocarditis according to the Dallas criteria. There were no differences in the degree of myocyte hypertrophy or fibrosis in PVB19 positive versus negative EMBx. PVB19, a single-stranded DNA virus and common childhood infection, was the only virus isolated from EMBx samples in this series of adult heart failure patients from the United States. The relationship between between PVB19 viral persistence and the development of cardiomyopathy merits further study.