What is the clinical evidence from this study?

Study design: Observational. Population: End-stage dilated cardiomyopathy (n=40). Intervention: Enterovirus RNA detection vs. Other specific heart muscle diseases. Primary outcome: Presence of enterovirus-specific RNA in myocardium.

What question did this study set out to answer?

To investigate whether enterovirus-specific RNA persists in the myocardium of patients with end-stage idiopathic dilated cardiomyopathy and whether this persistence triggers an active immune response.

November 1, 1989Circulation

End-stage dilated cardiomyopathy. Persistence of enterovirus RNA in myocardium at cardiac transplantation and lack of immune response.

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Key result

Enterovirus RNA persisted in the explanted myocardium of 28.6% of patients with end-stage dilated cardiomyopathy versus 5.3% with other heart diseases, in the absence of an immune response.

Why the study?

Does enterovirus RNA persist in the myocardium of patients with end-stage dilated cardiomyopathy at the time of cardiac transplantation?

Population

40 patients undergoing cardiac transplantation

Comparison

Tissue analysis of explanted hearts for… vs Patients with other specific heart muscle diseases

Design

Cross-sectional

Authors

NBNeil E. BowlesNorthwestern University MRMarlene L. RoseHarefield Hospital PTPeter C. TaylorUniversity of Oxford

Discussion

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Implication

May implicate occult enterovirus in end-stage DCM without inflammation; hypothesis-generating and requires prospective validation.

Key Points

To investigate whether enterovirus-specific RNA persists in the myocardium of patients with end-stage idiopathic dilated cardiomyopathy and whether this persistence triggers an active immune response.
Analyzed explanted myocardial tissue from 21 patients with idiopathic dilated cardiomyopathy and 19 patients with other specific heart muscle diseases.
Used a group-specific cDNA probe complementary to conserved coxsackievirus B2 RNA sequences (nucleotides 6,550 to 7,400) to detect enteroviral RNA.
Evaluated host immune responses using coxsackievirus B-specific IgM serology, myocardial leukocyte and T-lymphocyte counts, and major histocompatibility antigen expression.
Enterovirus RNA was identified in explanted heart tissue from 6 of 21 patients with dilated cardiomyopathy and 1 of 19 patients with ischemic heart disease.
Only 1 patient (in the dilated cardiomyopathy group) was positive for coxsackievirus B-specific IgM, and this patient tested negative for myocardial viral RNA.
Quantitation of myocardial leukocytes, T-lymphocytes, and major histocompatibility locus antigens showed no significant differences associated with viral RNA persistence.

Study Design

Type

Observational (n=40)

Structured PICO

Does enterovirus RNA persist in the myocardium of patients with end-stage dilated cardiomyopathy at the time of cardiac transplantation?

Population

40 patients undergoing cardiac transplantation (21 with idiopathic dilated cardiomyopathy, 19 with other specific heart muscle diseases)

Intervention

Tissue analysis of explanted hearts for enterovirus-specific RNA using a cDNA probe, serology, and immune cell quantitation

Comparator

Patients with other specific heart muscle diseases

Outcome

Presence of enterovirus RNA in explanted myocardiumsurrogate

Main Result

Absolute Event Rate: 28.6% vs 5.3%

Enterovirus RNA persists in the myocardium of a significant proportion of patients with end-stage dilated cardiomyopathy without evidence of a continuing cell-mediated or humoral immune response.

Cite This Study

Bowles et al. (1989) conducted an observational in End-stage dilated cardiomyopathy (n=40). Enterovirus RNA detection vs. Other specific heart muscle diseases was evaluated on Presence of enterovirus-specific RNA in myocardium. Enterovirus RNA persisted in the explanted myocardium of 28.6% of patients with end-stage dilated cardiomyopathy versus 5.3% with other heart diseases, in the absence of an immune response.

synapsesocial.com/papers/6a0f18481cf410a932425b26 https://doi.org/10.1161/01.cir.80.5.1128

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End-stage dilated cardiomyopathy. Persistence of enterovirus RNA in myocardium at cardiac transplantation and lack of immune response.

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

End-stage dilated cardiomyopathy. Persistence of enterovirus RNA in myocardium at cardiac transplantation and lack of immune response.

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Also Consider