Enteroviruses can persist with or without active viral replication in cardiac tissue of patients with end-stage ischemic or dilated cardiomyopathy

To investigate enterovirus replication versus persistence in end-stage card iac diseases, endomyocardial biopsies from explanted hearts of 70 patients with idiopathic dilated cardiomyopathy (IDCM), 64 patients with chronic cor onary disease (CCD), and 45 donors of healthy hearts (controls) were examin ed by reverse transcriptase-polymerase chain reaction for genomic and antig enomic enterovirus RNA and by VP1 antigen immunohistochemistry. Enterovirus genome was detected in 25 of 70 patients with IDCM and in 21 of 64 patient s with CCDs (35.7 vs. 32.8%, respectively; P = .12). Of the 46 patients pos itive for genomic RNA, only 3 exhibited antigenomic RNA and VP1 antigen tha t demonstrated active viral replication, whereas 43 had latent infection ch aracterized by the absence of antigenomic RNA associated with or not with V P1 antigen expression. No viral component was detected in control subjects. The findings demonstrate that a small percentage of patients with end-stag e chronic cardiac diseases had active enterovirus replication in their myoc ardium.