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Predictors of outcome in patients with parvovirus B19 positive endomyocardial biopsy

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Abstract

Objective

Primary objective was to establish the prognostic value of the myocardial load of PVB19 genomes in patients presenting for work-up of myocarditis and/or unclear cardiomyopathy in comparison to clinical, and CMR parameters.

Methods

108 consecutive patients who underwent EMB because of suspected myocarditis and/or unclear cardiomyopathy, and had evidence of myocardial PVB19 genome, were enrolled. Primary endpoint was all-cause mortality; secondary endpoint was a composite of cardiac mortality and hospitalization for heart failure.

Results

Mean LV-EF was 40 %. We found n = 27 patients to have a viral load ≥500 GE (IQR 559–846), n = 72 had 100–499 GE, and n = 9 had <100 GE. Immunohistology revealed chronic myocarditis in n = 66, acute myocarditis in n = 1, DCM in n = 17, PVB19 genome only in n = 13, and other pathologies in n = 11. During follow-up 11 patients died, two suffered SCD but were successfully shocked by ICD, and 21 were hospitalized for heart failure. Interestingly, not the viral load, but functional parameters such as LV-EF, LV-EDV (endpoint 2), as well as the histologic diagnosis of DCM and the presence of LGE (for all endpoints) reached statistical significance. In fact, the presence of LGE yields an odds-ratio for a lethal event of 8.56 (endpoint 1), and of 5.52 for endpoint 2. No patient with normal LV-EF, or the absence of LGE, suffered cardiac death during long-term follow-up.

Conclusion

The viral load of PVB19 genomes in the myocardium is not related to the long-term outcome. Furthermore, this study suggests a growing role of imaging for risk stratification in non-ischemic myocardial disease.

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Abbreviations

CAD:

Coronary artery disease

CMR:

Cardiovascular magnetic resonance

DCM:

Dilated cardiomyopathy

ECG:

Electrocardiogram

GE:

Genome equivalents per microgram of isolated nucleic acids

HR:

Hazard ratio

ICD:

Implantable cardioverter-defibrillator

IQR:

Interquartile range

LGE:

Late gadolinium enhancement

LV:

Left ventricle

LV-EDV:

Left ventricular end-diastolic volume

LV-EF:

Left ventricular ejection fraction

LV-ESV:

Left ventricular end-systolic volume

PVB19:

Parvovirus B19

SCD:

Sudden cardiac death

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Acknowledgments

This work was funded in part by the Robert Bosch Foundation (1) clinical research grant for CMR risk stratification in HCM and (2) clinical research grant for inflammatory heart disease KKF-11-18, KKF-13-2. The authors thank Prof. Dr. Dr. Günter Schneider, Universitätsklinikum des Saarlandes, Klinik für Radiologie, Homburg/Saar, Germany for supporting CMR Analysis in Homburg.

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Authors and Affiliations

  1. Division of Cardiology, Robert-Bosch-Medical Center, Auerbachstrasse 110, 70376, Stuttgart, Germany

    Simon Greulich, Julia Schumm, Stefan Birkmeier, Stefan Grün, Peter Ong, Tim Schäufele, Udo Sechtem & Heiko Mahrholdt

  2. Universitätsklinikum des Saarlandes, Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Homburg/Saar, Germany

    Ingrid Kindermann & Michael Böhm

  3. Division of Cardiology, Horst-Schmidt-Kliniken, Wiesbaden, Germany

    Julia Schumm

  4. Department of Medicine II, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany

    Andrea Perne

  5. Universitätsklinikum Tübingen, Abteilung für Molekulare Pathologie, Tübingen, Germany

    Karin Klingel & Reinhard Kandolf

  6. Institut für Herzinfarktforschung Ruhr, Essen, Germany

    Steffen Schneider

Authors
  1. Simon Greulich
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  2. Ingrid Kindermann
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Corresponding author

Correspondence to Heiko Mahrholdt.

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None.

Informed consent

All patients gave informed consent prior to their inclusion in the study; the study protocol conformed to the ethical guidelines of the 1964 Declaration of Helsinki and its later amendments.

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Greulich, S., Kindermann, I., Schumm, J. et al. Predictors of outcome in patients with parvovirus B19 positive endomyocardial biopsy. Clin Res Cardiol 105, 37–52 (2016). https://doi.org/10.1007/s00392-015-0884-6

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  • DOI: https://doi.org/10.1007/s00392-015-0884-6

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