Author + information
- Kathleen Simpson,
- Gregory A. Storch,
- Caroline K. Lee,
- Madeleine Cunningham,
- Kent Ward,
- Alan Tong,
- Catherine Simon,
- Jeffrey Delaney,
- Saar Danon and
- Charles Canter
A viral etiology is the commonly accepted cause of acute myocarditis/acute onset dilated cardiomyopathy (MC/DCM) in children. The prevalence of viremia in children with MC/DCM at diagnosis is unknown. We hypothesized viral infection identified via peripheral viral blood PCR at time of presentation of acute clinical MC/DCM could identify known cardiotropic viruses in pediatric patients at a higher rate than in pediatric controls.
A total of 19 children presenting with acute onset (≤ 6 weeks from onset of symptoms) MC/DCM were prospectively evaluated for the presence of cardiotropic viruses (enterovirus, adenovirus, parvovirus B19, human herpes virus 6) as part of their initial diagnostic evaluation at time of presentation. MC/DCM was defined as the presence of an echocardiographic left ventricular (LV) shortening fraction age-specific z-score < −2 with or without an LV diastolic dimension z-score > 2. The prevalence of positive viral blood PCRs in the MC/DCM group was compared to the prevalence of these viruses in healthy pediatric controls (n=108).
A respiratory or gastrointestinal prodrome was reported in 81% of MC/DCM patients. Peripheral viral blood PCR was positive in 43% (n=9) of patients for known cardiotropic viruses; enterovirus (4), adenovirus (1), parvovirus B19 (2), HHV6 (2). MC/DCM patients had a significantly higher rate of positive blood PCR for these cardiotropic viruses compared to healthy pediatric controls (43% vs. 8%, p=0.0003). In the 4 MC/DCM patients who had endomyocardial biopsies, no patients had positive myocardial viral PCR studies.
This pilot data suggests a variety of cardiotropic viruses are frequently observed in the blood of pediatric MC/DCM patients at a significantly higher rate than healthy children. Further studies are needed to confirm these findings and determine the relationship between evidence of viremia by peripheral PCR and MC/DCM in children.
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: Myocarditis: Mechanistic Insights
Abstract Category: 23. Pericardial/Myocardial Disease
Presentation Number: 1207-149
- 2013 American College of Cardiology Foundation