Cor Vasa 2013, 55(4):e333-e340 | DOI: 10.1016/j.crvasa.2013.02.003

Impact of inflammatory infiltration and viral genome presence in myocardium on the changes of echocardiographic parameters

Jan Krejčí^a,*, Hana Poloczková^a, Petr Hude^a, Tomáš Freiberger^c, Eva Němcová^c,d, Víta Žampachová^b, Alžběta Sirotková^b, Radka Štěpánová^d, Lenka Špinarová^a, Petr Němec^c,d, Jiří Vítovec^a

^a I. interní kardioangiologická klinika, Lékařská fakulta Masarykovy univerzity a Fakultní nemocnice u sv. Anny v Brně, International Clinical Research Center, Brno, Česká republika

^b 1. patologický ústav Masarykovy univerzity a Fakultní nemocnice u sv. Anny v Brně, Brno, Česká republika

^c Centrum kardiovaskulární a transplantační chirurgie, Brno, Česká republika

^d International Clinical Research Center, Brno, Česká republika

Patients and methods: 70 patients with a recent occurrence of DCM with left ventricle ejection fraction (LVEF) < 40 % and with the history of symptoms less than 12 months were enrolled to observation. In EMB samples the average number of T-lymphocytes (CD3+ cells) and mononuclear leucocytes (LCA+ cells) in mm2 was determined. The presence of inflammation was evaluated as positive in case of findings > 7 CD3+ cells and/or > 14 LCA+ cells in mm². The detection of pathological agents in myocardium was performed by quantitative polymerase chain reaction (PCR).

Results: According to immunohistological (IH) assessment findings were positive (IH+) in 35 patients (i.e. 50%); thus the inflammatory infiltration was present in myocardium. In remaining patients the findings were negative (IH-). At 6-month follow-up, in the group of IH+ patients the LVEF improved from 25 ± 9% to 39 ± 11% and NYHA class declined from 2.8 ± 0.5 to 1.7 ± 0.6 (both p < 0.001). In IH- group change in LVEF (from 23 ± 8% to 27 ± 10%) in contrast to the change of NYHA class (from 2.5 ± 0.5 to 2.1 ± 0.7; p < 0.05) was not found statistically significant. Comparing changes in parameters between both groups, the IH+ group has significantly more improved in LVEF (p < 0.01) as well as in the NYHA class (p < 0.001). Viral genome was detected (PCR was positive, PCR+) in 43 patients (i.e. 61%). At 6-month follow-up, there were statistically significant changes of LVEF in PCR+ group (from 25 ± 8% to 34 ± 12%; p < 0.01) and also in PCR- group (from 22 ± 8% to 32 ± 12%; p < 0.001). The difference in changes of LVEF between these two groups was not statistically significant. Change in NYHA class was statistically significant and comparably reduced in both groups (from 2.6 ± 0.5 to 1.9 ± 0.6; p < 0.001; and from 2.7 ± 0.6 to 2.0 ± 0.7; p < 0.001, respectively).

Conclusion: Patients with a recent occurrence of non-ischemic LV dysfunction and biopsy proven myocarditis have been found to show statistically significant improvement in the LV systolic function and functional status in comparison to the group of patients with no evidence of inflammatory infiltration in 6-month follow-up. On the contrary, the presence or absence of viruses in myocardium has no impact on the changes in these parameters.

Keywords: Dilated cardiomyopathy; Endomyocardial biopsy; Inflammatory cardiomyopathy; Myocarditis

Received: January 24, 2013; Revised: February 5, 2013; Accepted: February 18, 2013; Published: August 1, 2013  Show citation