Detection of adenoviral genome in the myocardium of adult patients with idiopathic left ventricular dysfunction

Background-The use of molecular biological techniques has demonstrated the importance of enteroviral infection of the myocardium in the pathogenesis o f myocarditis and dilated cardiomyopathy in adults and adenovirus and enter ovirus infection in children. The aim of this study was to determine the fr equency of adenoviral infection of the myocardium of adults with impaired l eft ventricular function of unknown origin. Methods and Results-Nested polymerase chain reaction (nPCR) was used to det ermine the frequency of detection of adenoviral DNA and enteroviral RNA in myocardial tissue samples from 94 adult patients with idiopathic left ventr icular dysfunction and 14 control patients. Histological and immunohistolog ical analyses were performed to detect myocardial inflammation. Adenoviral genomic DNA was detected by nPCR in 12 of the 94 patients with left ventric ular dysfunction (in each case, adenovirus type 2), whereas enteroviral RNA was detected in another 12 patients. All control samples were negative for both viruses. In all patients, active myocarditis was excluded according t o the Dallas criteria However, there was significantly decreased CD2, CD3, and CD45RO T lymphocyte counts in the adenovirus-positive group compared wi th the adenovirus-negative group (P<0.05), whereas no differences were asso ciated with enterovirus infection. Conclusions-Although enteroviruses are an important causative agent in the pathogenesis of myocarditis and dilated cardiomyopathy, this study shows th at adenovirus infection is also important in the pathogenesis of left ventr icular failure in adults. However, the pathogenetic basis of disease associ ated with adenovirus infection may be different than that after infection w ith ether agents, particularly with respect to activation of the host immun e response.