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Predictors of outcome in patients with Parvovirus B19 positive endomyocardial biopsy

S. Greulich, J. Schumm, A. Perne, S. Gruen, P. Ong, K. Klingel, R. Kandolf, U. Sechtem, H. Mahrholdt
DOI: http://dx.doi.org/10.1093/eurheartj/eht309.3508 First published online: 1 August 2013


Purpose: Viral loads of PVB19 have been shown to be associated with inflammation and development of dilated cardiomyopathy (DCM). The long-term outcome of patients with evidence of PVB19 in EMB still remains unclear. We sought to evaluate the long-term outcome in patients with parvovirus B19 positive endomyocardial biopsy (EMB), and to establish the prognostic value of various clinical, functional and CMR parameters in these patients.

Methods: 104 consecutive patients who underwent EMB because of suspected myocarditis or unclear cardiomyopathy and had evidence of PVB19 in PCR analyses were enrolled. The mean follow-up was 1281±377 days. Primary endpoint was all-cause mortality, secondary endpoint was a composite of mortality and hospitalization for heart-failure.

Results: Mean ejection fraction of all patients was 45.4%. There were no significant differences comparing patients suffering from all-cause death with patients who suffered no event regarding ejection fraction, age, or viral copy load. We found n=28 patients to have a viral load ≥500 copies/μg myocardial nucleic acid, n= 69 had 100-499 copies/μg and n=7 had <100 copies. Immunohistology showed chronic myocarditis in n=63 patients, DCM in n=17, other pathologies in n=14 and no abnormalities in n=10. We found a long-term mortality of 10.6% (n=11). In 8 of the 11 deaths CMR was performed, 5 of them showed Late Gadolinium Enhancement (LGE) and all these 5 patients suffered SCD. Multivariate Cox-Regression analysis including age, ejection fraction and viral load showed no significant influence of any of these factors with regard to the primary endpoint. For the secondary endpoint, ejection fraction was the sole independently associated factor (hazard ratio 0.977, p=0.043).

Conclusion: Among our population with a wide range of PVB19 viral load copies, the amount of viral load copies seems not to be associated with an unfavourable outcome (mortality). In addition, the presence of scar indicated by LGE seems to be a good predictor of of cardiac mortality.