Search tips
Search criteria 


Logo of brheartjLink to Publisher's site
Br Heart J. 1992 December; 68(6): 554–559.
PMCID: PMC1025684

Similar prevalence of enteroviral genome within the myocardium from patients with idiopathic dilated cardiomyopathy and controls by the polymerase chain reaction


Objective—To assess the prevalence and significance of enteroviral genome within myocardial biopsy specimens taken from patients with idiopathic dilated cardiomyopathy and from controls.

Design—Prospective evaluation of myocardial tissue for the presence of an enteroviral genome by the polymerase chain reaction.

Setting—A tertiary referral centre for patients with idiopathic dilated cardiomyopathy.

Patients—Tissue for the study came from 50 consecutive patients with dilated cardiomyopathy, 41 with other forms of heart disease and 34 from coroners' necropsy cases.

Results—Enteroviral genome was detected in 6/50 (12%) patients with dilated cardiomyopathy and 13/75 (17%) of the controls (not significant). No differences were seen between dilated cardiomyopathy patients with or without myocardial enteroviral genome in respect of age; duration of symptoms; proportion of patients with a premorbid acute viral illness, excess alcohol consumption, or hypertension; New York Heart Association functional class; measures of left ventricular function; or endomyocardial histology. Within the control group enteroviral genome was detected in 3/15 (20%) patients with ischaemic heart disease, 2/19 (10·5%) with valvar heart disease, 1/5 (20%) with specific heart muscle disease, 0/2 (0%) with congenital heart disease, and 7/34 (20·6%) cases of sudden death. During 2–52 month follow up (mean 22) 15/44 (34%) patients without myocardial enteroviral genome and 2/6 (33%) with myocardial enteroviral genome died suddenly or required orthotopic heart transplantation for progressive heart failure.

Conclusions—These findings do not support the hypothesis that persistent enteroviral infection is of pathogenic or prognostic importance in dilated cardiomyopathy but they are consistent with enterovirus being a common environmental pathogen.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.3M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Cambridge G, MacArthur CG, Waterson AP, Goodwin JF, Oakley CM. Antibodies to Coxsackie B viruses in congestive cardiomyopathy. Br Heart J. 1979 Jun;41(6):692–696. [PMC free article] [PubMed]
  • Wilson FM, Miranda QR, Chason JL, Lerner AM. Residual pathologic changes following murine coxsackie A and B myocarditis. Am J Pathol. 1969 May;55(2):253–265. [PubMed]
  • Woodruff JF. Viral myocarditis. A review. Am J Pathol. 1980 Nov;101(2):425–484. [PubMed]
  • Matoba Y, Matsumori A, Ohtani H, Tominaga M, Fujiwara H, Toyokuni S, Takahashi K, Midorikawa O, Kawai C. A case of biopsy-proven myocarditis progressing to autopsy-proven dilated cardiomyopathy. Clin Cardiol. 1990 Oct;13(10):732–737. [PubMed]
  • Kawai C. Idiopathic cardiomyopathy. A study on the infectious-immune theory as a cause of the disease. Jpn Circ J. 1971 Jul;35(7):765–770. [PubMed]
  • Fletcher GF, Coleman MT, Feorino PM, Marine WM, Wenger NK. Viral antibodies in patients with primary myocardial disease. Am J Cardiol. 1968 Jan;21(1):6–10. [PubMed]
  • Muir P, Nicholson F, Tilzey AJ, Signy M, English TA, Banatvala JE. Chronic relapsing pericarditis and dilated cardiomyopathy: serological evidence of persistent enterovirus infection. Lancet. 1989 Apr 15;1(8642):804–807. [PubMed]
  • Miller NA, Carmichael HA, Calder BD, Behan PO, Bell EJ, McCartney RA, Hall FC. Antibody to Coxsackie B virus in diagnosing postviral fatigue syndrome. BMJ. 1991 Jan 19;302(6769):140–143. [PMC free article] [PubMed]
  • Grasso M, Arbustini E, Silini E, Diegoli M, Percivalle E, Ratti G, Bramerio M, Gavazzi A, Vigano M, Milanesi G. Search for Coxsackievirus B3 RNA in idiopathic dilated cardiomyopathy using gene amplification by polymerase chain reaction. Am J Cardiol. 1992 Mar 1;69(6):658–664. [PubMed]
  • Tracy S, Wiegand V, McManus B, Gauntt C, Pallansch M, Beck M, Chapman N. Molecular approaches to enteroviral diagnosis in idiopathic cardiomyopathy and myocarditis. J Am Coll Cardiol. 1990 Jun;15(7):1688–1694. [PubMed]
  • Jin O, Sole MJ, Butany JW, Chia WK, McLaughlin PR, Liu P, Liew CC. Detection of enterovirus RNA in myocardial biopsies from patients with myocarditis and cardiomyopathy using gene amplification by polymerase chain reaction. Circulation. 1990 Jul;82(1):8–16. [PubMed]
  • Ross RS, Chien KR. Of molecules and myocardium. PCR diagnosis of viral myocarditis in cardiac biopsies. Circulation. 1990 Jul;82(1):294–295. [PubMed]
  • Rotbart HA. Enzymatic RNA amplification of the enteroviruses. J Clin Microbiol. 1990 Mar;28(3):438–442. [PMC free article] [PubMed]
  • Jones RO. Retirement — a process of gradual disengagement. Can Med Assoc J. 1981 May 15;124(10):1393–1397. [PMC free article]
  • Henry WL, Gardin JM, Ware JH. Echocardiographic measurements in normal subjects from infancy to old age. Circulation. 1980 Nov;62(5):1054–1061. [PubMed]
  • Aretz HT, Billingham ME, Edwards WD, Factor SM, Fallon JT, Fenoglio JJ, Jr, Olsen EG, Schoen FJ. Myocarditis. A histopathologic definition and classification. Am J Cardiovasc Pathol. 1987 Jan;1(1):3–14. [PubMed]
  • Chomczynski P, Sacchi N. Single-step method of RNA isolation by acid guanidinium thiocyanate-phenol-chloroform extraction. Anal Biochem. 1987 Apr;162(1):156–159. [PubMed]
  • Chapman NM, Tracy S, Gauntt CJ, Fortmueller U. Molecular detection and identification of enteroviruses using enzymatic amplification and nucleic acid hybridization. J Clin Microbiol. 1990 May;28(5):843–850. [PMC free article] [PubMed]
  • Tracy S. Comparison of genomic homologies in the coxsackievirus B group by use of cDNA:RNA dot-blot hybridization. J Clin Microbiol. 1985 Mar;21(3):371–374. [PMC free article] [PubMed]
  • Archard LC, Bowles NE, Cunningham L, Freeke CA, Olsen EG, Rose ML, Meany B, Why HJ, Richardson PJ. Molecular probes for detection of persisting enterovirus infection of human heart and their prognostic value. Eur Heart J. 1991 Aug;12 (Suppl 500):56–59. [PubMed]
  • Weiss LM, Movahed LA, Billingham ME, Cleary ML. Detection of Coxsackievirus B3 RNA in myocardial tissues by the polymerase chain reaction. Am J Pathol. 1991 Feb;138(2):497–503. [PubMed]
  • Bowles NE, Rose ML, Taylor P, Banner NR, Morgan-Capner P, Cunningham L, Archard LC, Yacoub MH. End-stage dilated cardiomyopathy. Persistence of enterovirus RNA in myocardium at cardiac transplantation and lack of immune response. Circulation. 1989 Nov;80(5):1128–1136. [PubMed]
  • Kohne DE, Gibbs CJ, White L, Tracy SM, Meinke W, Smith RA. Virus detection by nucleic acid hybridization: examination of normal and ALS tissues for the presence of poliovirus. J Gen Virol. 1981 Oct;56(Pt 2):223–233. [PubMed]
  • Foulis AK, Farquharson MA, Cameron SO, McGill M, Schönke H, Kandolf R. A search for the presence of the enteroviral capsid protein VP1 in pancreases of patients with type 1 (insulin-dependent) diabetes and pancreases and hearts of infants who died of coxsackieviral myocarditis. Diabetologia. 1990 May;33(5):290–298. [PubMed]
  • Tracy S, Chapman NM, McManus BM, Pallansch MA, Beck MA, Carstens J. A molecular and serologic evaluation of enteroviral involvement in human myocarditis. J Mol Cell Cardiol. 1990 Apr;22(4):403–414. [PubMed]
  • Easton AJ, Eglin RP. The detection of coxsackievirus RNA in cardiac tissue by in situ hybridization. J Gen Virol. 1988 Feb;69(Pt 2):285–291. [PubMed]
  • Neu N, Craig SW, Rose NR, Alvarez F, Beisel KW. Coxsackievirus induced myocarditis in mice: cardiac myosin autoantibodies do not cross-react with the virus. Clin Exp Immunol. 1987 Sep;69(3):566–574. [PubMed]

Articles from British Heart Journal are provided here courtesy of BMJ Group