CLINICAL AND PROGNOSTIC-SIGNIFICANCE OF DETECTION OF ENTEROVIRAL RNA IN THE MYOCARDIUM OF PATIENTS WITH MYOCARDITIS OR DILATED CARDIOMYOPATHY

Background Enteroviral RNA sequences have been demonstrated in the myo cardium of patients with myocarditis or dilated cardiomyopathy from pr esentation to end-stage disease. The prognosis of heart muscle disease has not previously been evaluated in relation to the detection of ent erovirus in myocardial biopsy tissue. Methods and Results We studied 1 23 consecutive patients with heart muscle disease prospectively. Multi ple endomyocardial biopsy samples taken from all patients during diagn ostic cardiac catheterization were classified histologically and were examined for enteroviral RNA by use of an enterovirus group-specific h ybridization probe. Three enterovirus-negative patients with cardiac a myloidosis were excluded from subsequent analysis. Enteroviral RNA seq uences were detectable in 41 (34%) of the remaining 120 patients (grou p A), while 79 (66%) had no virus detected (group B). The groups did n ot differ significantly in age, sex, symptomatic presentation, or hemo dynamic characteristics; duration of symptoms was significantly shorte r in group A (7.8+/-9.6 versus 14.9+/-19.0 months, P<.05). At follow-u p (mean, 25 months; range, 11 to 50 months), patients from group A had an increased mortality compared with those in group B (25% versus 4%, respectively; P=.02). Mortality was also statistically greater in pat ients with symptomatic cardiac failure (P=.02), those with elevated le ft ventricular end-diastolic pressures (P=.03), and those in New York Heart Association functional classes III and IV (P=.05). Multivariate regression analysis, however, showed that only the presence of enterov irus RNA and symptomatic heart failure were of independent prognostic value. Conclusions These data demonstrate that the detection of entero virus RNA in the myocardium of patients with heart muscle disease at t he time of initial investigation is associated with an adverse prognos is and that the presence of enterovirus RNA is an independent predicto r of clinical outcome.