Cor Vasa 2009, 51(9):572-577 | DOI: 10.33678/cor.2009.141

Comprehensive biopsy-based diagnosis of inflammatory cardiomyopathy as a cause of new-onset heart failure of unclear etiology: initial experience

Petr Kuchynka¹, Tomáš Paleček^1,*, Stanislav Šimek¹, Jan Horák¹, Ivana Vítková², Jana Schramlová³, Dagmar Hulínská³, Viktor Aster⁴, Michael Aschermann¹, Aleš Linhart¹

¹ 2. interní klinika kardiologie a angiologie

² Ústav patologie, Všeobecná fakultní nemocnice a 1. lékařská fakulta Univerzity Karlovy

³ Státní zdravotní ústav

⁴ III. klinika infekčních a tropických nemocí, Fakultní nemocnice Na Bulovce a 1. lékařská fakulta Univerzity Karlovy, Praha, Česká republika

Background and aim of the study: Dilated cardiomyopathy is caused by various myocardial diseases leading to global left ventricular (LV) systolic dysfunction. The aim of our study was to assess the prevalence of inflammatory dilated cardiomyopathy (IDCM) in patients with new-onset heart failure and unexplained LV systolic dysfunction.

Methods: From January 2007 to September 2008, endomyocardial biopsy (EMB) was performed in 27 subjects (49 ± 12 years, 11 women) with new-onset heart failure due to unexplained dilated cardiomyopathy, with an LV ejection fraction < 40%. Endomyocardial biopsy specimens were analyzed immunohistochemically, by electron microscopy, and polymerase chain reaction in an effort to demonstrate the presence of cardiotropic viruses and Borrelia burgdorferi.

Results: The presence of a microbial agent in EMB was demonstrated in 15 subjects (56%), with immunohistochemical evidence of myocardial inflammation in an additional 6 cases (22%). Isolated inflammatory changes, as demonstrated by immunohistochemical analysis, were present in 4 subjects (15%). Herpesviridae (HSV 1 and HHV 6) and Enteroviridae were the most frequently detected viral families. Regarding bacterial agents, Borrelia burgdorferi infection was present in a relatively high number of cases (22%).

Conclusions: Inflammatory dilated cardiomyopathy seems to be a frequent cause of new-onset unexplained LV systolic dysfunction. A comprehensive analysis of EMB specimens based on modern immunohistochemical and microbiological approaches is essential for the diagnosis of IDCM. The high prevalence of myocardial Borrelia burgdorferi infection probably reflects its endemicity in the Czech Republic.

Keywords: Inflammatory cardiomyopathy; Endomyocardial biopsy; Virus; Borrelia burgdorferi

Published: September 1, 2009  Show citation