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Diagnosis of viral myocarditis by cardiac magnetic resonance and viral genome detection in peripheral blood

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Abstract

In patients with acute myocarditis, viral genome can be detected in plasma and peripheral leukocytes. Its relationship with active myocardial inflammation, however, is not well understood. Myocardial edema as a feature of inflammation and myocardial necrosis or fibrosis can be frequently observed in patients with acute myocarditis by cardiovascular magnetic resonance (CMR). We assessed the association of viral genome presence in peripheral blood samples with myocardial edema and irreversible injury. We examined consecutive patients with clinically suspected myocarditis after an episode of viral illness. State-of-the-art methods were used for detecting myocardial edema and irreversible injury using CMR and viral genome applying reverse transcribed, nested polymerase chain reaction in peripheral blood samples. The specificity of viral amplification products was confirmed by automatic DNA sequencing. Of a total of 55 patients (53.5 ± 15.6 years), 21 were positive for viral genome in peripheral leukocytes. Interestingly, 18 (86 %) of these patients also showed global myocardial edema, as compared to only 7/34 (21 %) without PCR evidence for viral genome. The overall agreement between CMR criteria for edema and viral PCR was 84 %. In contrast, there was no significant relationship of viral genome presence with myocardial necrosis or scars. In patients with clinically suspected myocarditis, myocardial edema but not irreversible myocardial injury is associated with the presence of viral genome in peripheral blood.

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Abbreviations

CMR:

Cardiovascular magnetic resonance

ECG:

Electrocardiogram

EF:

Ejection fraction

GD-DTPA:

Gadolinium-diethylenetriaminepentaacetate

LV:

Left ventricular, left ventricle

LGE:

Late gadolinium enhancement

PCR:

Polymerase chain reaction

STIR:

Fast spin echo triple inversion recovery sequence (s)

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Acknowledgments

We would like to thank Petra Nuß for collecting the data and typing parts of the manuscript. This study was supported in part by the Deutsche Forschungsgemeinschaft within the Sonderforschungsbereich-Transregio 19 (SFB-TR19): Inflammatory Cardiomyopathy (R.K.).

Conflict of interest

None declared.

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Authors and Affiliations

  1. Medical Practice, Cardiology and Angiology, Koenigstr. 39, 90402, Nuernberg, Germany

    Michael Jeserich & Simone Kimmel

  2. Department of Cardiology and Angiology, Albert Ludwig University of Freiburg, Hugstetterstr. 55, 79106, Freiburg, Germany

    Michael Jeserich, Daniela Föll, Christoph Bode & Annette Geibel

  3. Department of Molecular Pathology, University Hospital Tübingen, Tübingen, Germany

    Eva Brunner & Reinhard Kandolf

  4. Department of Medical Biometry and Statistics, University of Freiburg, Freiburg im Breisgau, Germany

    Manfred Olschewski

  5. Departments of Cardiac Sciences and Radiology, University of Calgary, CMR Centre at the Montreal Heart Institute, Hornstein Chair in Cardiovascular Imaging, 5000 Rue Belanger, Montréal, QC, Canada

    Matthias G. Friedrich

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  1. Michael Jeserich
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  2. Eva Brunner
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  3. Reinhard Kandolf
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  4. Manfred Olschewski
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  8. Christoph Bode
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  9. Annette Geibel
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Correspondence to Michael Jeserich.

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Jeserich, M., Brunner, E., Kandolf, R. et al. Diagnosis of viral myocarditis by cardiac magnetic resonance and viral genome detection in peripheral blood. Int J Cardiovasc Imaging 29, 121–129 (2013). https://doi.org/10.1007/s10554-012-0052-2

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  • DOI: https://doi.org/10.1007/s10554-012-0052-2

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