Key result
Metagenomic NGS detects cardiotropic viruses in ~56% of PCR-negative myocarditis biopsies.
Why the study?
Conventional PCR often fails to detect causative viral pathogens in myocarditis, limiting diagnostic precision and therapeutic decision-making. Whether targeted metagenomic next-generation sequencing improves viral detection in endomyocardial biopsies compared with standard PCR was evaluated.
Does targeted metagenomic next-generation sequencing (NGS) improve viral detection in endomyocardial biopsies compared with conventional PCR in patients with clinically suspected myocarditis?
Observational (n=144)
Does targeted metagenomic next-generation sequencing (NGS) improve viral detection in endomyocardial biopsies compared with conventional PCR in patients with clinically suspected myocarditis?
Targeted metagenomic sequencing substantially improves viral detection in endomyocardial biopsies over conventional PCR and identifies clinically relevant infections associated with lower left ventricular ejection fraction.
Answers are grounded in this paper and cite their sources.
May support NGS for enhanced viral detection in myocarditis biopsies; leaves open whether this alters management or outcomes.
Background Viral infections are a leading cause of myocarditis; however, conventional polymerase chain reaction (PCR) often fails to detect causative pathogens, limiting diagnostic precision and therapeutic decision-making. Purpose We evaluated whether targeted metagenomic next-generation sequencing (NGS) improves viral detection in endomyocardial biopsies (EMB) compared with standard PCR and assessed its clinical relevance. Methods EMB samples from 144 patients with clinically suspected myocarditis underwent histologic and immunohistochemical assessment of myocardial inflammation. All samples were analyzed using conventional PCR for common cardiotropic viruses and compared with a targeted NGS panel covering 84 cardiotropic viruses. Viral detection and transcriptional activity were assessed and correlated with myocardial inflammation and left ventricular ejection fraction (LVEF). Results EMB confirmed myocarditis in 127 (88%) cases. NGS detected all 45 viral genomes identified by PCR and revealed an additional 31 viral genomes in PCR-positive patients, increasing diagnostic yield by 69%. Among PCR-negative patients, NGS identified viral genomes in 56%, uncovering high number of previously undiagnosed infections. Frequently detected viruses included parvovirus B19, Epstein-Barr virus, human herpesvirus 6, cytomegalovirus, and adenovirus, as well as less commonly recognized agents such as herpesvirus 7/8, adeno-associated virus, tetraparvovirus, and pegivirus C. Transcriptionally active parvovirus B19 was more frequently detected by NGS than PCR (31% vs. 14%). Patients with NGS-confirmed viral infections had significantly lower LVEF compared with virus-negative patients. Conclusions Targeted metagenomic sequencing substantially improves viral detection in EMB and identifies clinically relevant infections missed by PCR. These findings support the potential role of NGS as a complementary diagnostic tool in virus-associated myocarditis and heart failure.
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Baumeier et al. (2026) conducted an observational in Suspected myocarditis (n=144). Targeted metagenomic next-generation sequencing (NGS) panel covering 84 cardiotropic viruses vs. Conventional polymerase chain reaction (PCR) was evaluated on Viral detection in endomyocardial biopsies. Targeted metagenomic NGS increased viral detection by 69% in PCR-positive patients and identified viruses in 56% of PCR-negative myocarditis biopsies.
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