Acute myocarditis

Rapid diagnosis by PCR in children

Ameeta B. Martin, Steven Webber, F. Jay Fricker, Ronald Jaffe, Gail Demmler, Debra Kearney, Yao Hua Zhang, Joann Bodurtha, Bruce Gelb, Jiyuan Ni, J. Timothy Bricker, Jeffrey Towbin

Research output: Contribution to journalArticle

288 Citations (Scopus)

Abstract

Background: The diagnosis of viral myocarditis remains difficult and generally depends on clinical and histological criteria. Viral cultures and serology are often unrewarding, with low yields. The purpose of this study was to analyze the usefulness of polymerase chain reaction (PCR) in the rapid diagnosis of acute myocarditis in children. Methods and Results: PCR was used to analyze 38 myocardial tissue samples from 34 patients with suspected acute viral myocarditis and 17 control patients with congenital heart disease (14) or hypertrophic cardiomyopathy (3). Myocardial samples were obtained at the time of right ventricular biopsy (13 samples), from explanted hearts (18 samples) at transplantation, and from cardiac autopsy specimens (24 samples) and were evaluated for the presence of enterovirus, cytomegalovirus (CMV), adenovirus, and herpes simplex virus (HSV) using PCR primers designed to consensus and unique sequences of these viral genomes. Blood also was obtained at the time of biopsy (11) or transplant (18). In 26 of 38 myocardial samples (68%), viral genome was detected by PCR (15 adenoviral, 8 enteroviral, 2 HSV, 1 CMV), whereas all control myocardial samples and blood samples were negative. Four patients had positive viral cultures, and these matched the PCR findings. Disagreement with histopathology occurred in 13 of 26 PCR-positive specimens, usually associated with adenovirus. Conclusions: PCR offers a rapid, sensitive diagnostic method for myocardial viral infection. While enterovirus is an important etiological agent, adenovirus was more prevalent in this series and should be evaluated when etiology is sought PCR used in conjunction with standard endomyocardial biopsy appears to enhance the likelihood of detecting viral genome in the myocardium of patients with clinical evidence of myocarditis.

Original languageEnglish (US)
Pages (from-to)330-339
Number of pages10
JournalCirculation
Volume90
Issue number1
DOIs
StatePublished - Jan 1 1994
Externally publishedYes

Fingerprint

Myocarditis
Polymerase Chain Reaction
Viral Genome
Adenoviridae
Enterovirus
Cytomegalovirus
Biopsy
Hypertrophic Cardiomyopathy
Consensus Sequence
Human Herpesvirus 1
Virus Diseases
Simplexvirus
Serology
Heart Transplantation
Autopsy
Heart Diseases
Myocardium
Transplants

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Martin, A. B., Webber, S., Fricker, F. J., Jaffe, R., Demmler, G., Kearney, D., ... Towbin, J. (1994). Acute myocarditis: Rapid diagnosis by PCR in children. Circulation, 90(1), 330-339. https://doi.org/10.1161/01.CIR.90.1.330

Acute myocarditis : Rapid diagnosis by PCR in children. / Martin, Ameeta B.; Webber, Steven; Fricker, F. Jay; Jaffe, Ronald; Demmler, Gail; Kearney, Debra; Zhang, Yao Hua; Bodurtha, Joann; Gelb, Bruce; Ni, Jiyuan; Bricker, J. Timothy; Towbin, Jeffrey.

In: Circulation, Vol. 90, No. 1, 01.01.1994, p. 330-339.

Research output: Contribution to journalArticle

Martin, AB, Webber, S, Fricker, FJ, Jaffe, R, Demmler, G, Kearney, D, Zhang, YH, Bodurtha, J, Gelb, B, Ni, J, Bricker, JT & Towbin, J 1994, 'Acute myocarditis: Rapid diagnosis by PCR in children', Circulation, vol. 90, no. 1, pp. 330-339. https://doi.org/10.1161/01.CIR.90.1.330
Martin AB, Webber S, Fricker FJ, Jaffe R, Demmler G, Kearney D et al. Acute myocarditis: Rapid diagnosis by PCR in children. Circulation. 1994 Jan 1;90(1):330-339. https://doi.org/10.1161/01.CIR.90.1.330
Martin, Ameeta B. ; Webber, Steven ; Fricker, F. Jay ; Jaffe, Ronald ; Demmler, Gail ; Kearney, Debra ; Zhang, Yao Hua ; Bodurtha, Joann ; Gelb, Bruce ; Ni, Jiyuan ; Bricker, J. Timothy ; Towbin, Jeffrey. / Acute myocarditis : Rapid diagnosis by PCR in children. In: Circulation. 1994 ; Vol. 90, No. 1. pp. 330-339.
@article{144a562b52b64bc282558ce13e132940,
title = "Acute myocarditis: Rapid diagnosis by PCR in children",
abstract = "Background: The diagnosis of viral myocarditis remains difficult and generally depends on clinical and histological criteria. Viral cultures and serology are often unrewarding, with low yields. The purpose of this study was to analyze the usefulness of polymerase chain reaction (PCR) in the rapid diagnosis of acute myocarditis in children. Methods and Results: PCR was used to analyze 38 myocardial tissue samples from 34 patients with suspected acute viral myocarditis and 17 control patients with congenital heart disease (14) or hypertrophic cardiomyopathy (3). Myocardial samples were obtained at the time of right ventricular biopsy (13 samples), from explanted hearts (18 samples) at transplantation, and from cardiac autopsy specimens (24 samples) and were evaluated for the presence of enterovirus, cytomegalovirus (CMV), adenovirus, and herpes simplex virus (HSV) using PCR primers designed to consensus and unique sequences of these viral genomes. Blood also was obtained at the time of biopsy (11) or transplant (18). In 26 of 38 myocardial samples (68{\%}), viral genome was detected by PCR (15 adenoviral, 8 enteroviral, 2 HSV, 1 CMV), whereas all control myocardial samples and blood samples were negative. Four patients had positive viral cultures, and these matched the PCR findings. Disagreement with histopathology occurred in 13 of 26 PCR-positive specimens, usually associated with adenovirus. Conclusions: PCR offers a rapid, sensitive diagnostic method for myocardial viral infection. While enterovirus is an important etiological agent, adenovirus was more prevalent in this series and should be evaluated when etiology is sought PCR used in conjunction with standard endomyocardial biopsy appears to enhance the likelihood of detecting viral genome in the myocardium of patients with clinical evidence of myocarditis.",
author = "Martin, {Ameeta B.} and Steven Webber and Fricker, {F. Jay} and Ronald Jaffe and Gail Demmler and Debra Kearney and Zhang, {Yao Hua} and Joann Bodurtha and Bruce Gelb and Jiyuan Ni and Bricker, {J. Timothy} and Jeffrey Towbin",
year = "1994",
month = "1",
day = "1",
doi = "10.1161/01.CIR.90.1.330",
language = "English (US)",
volume = "90",
pages = "330--339",
journal = "Circulation",
issn = "0009-7322",
publisher = "Lippincott Williams and Wilkins",
number = "1",

}

TY - JOUR

T1 - Acute myocarditis

T2 - Rapid diagnosis by PCR in children

AU - Martin, Ameeta B.

AU - Webber, Steven

AU - Fricker, F. Jay

AU - Jaffe, Ronald

AU - Demmler, Gail

AU - Kearney, Debra

AU - Zhang, Yao Hua

AU - Bodurtha, Joann

AU - Gelb, Bruce

AU - Ni, Jiyuan

AU - Bricker, J. Timothy

AU - Towbin, Jeffrey

PY - 1994/1/1

Y1 - 1994/1/1

N2 - Background: The diagnosis of viral myocarditis remains difficult and generally depends on clinical and histological criteria. Viral cultures and serology are often unrewarding, with low yields. The purpose of this study was to analyze the usefulness of polymerase chain reaction (PCR) in the rapid diagnosis of acute myocarditis in children. Methods and Results: PCR was used to analyze 38 myocardial tissue samples from 34 patients with suspected acute viral myocarditis and 17 control patients with congenital heart disease (14) or hypertrophic cardiomyopathy (3). Myocardial samples were obtained at the time of right ventricular biopsy (13 samples), from explanted hearts (18 samples) at transplantation, and from cardiac autopsy specimens (24 samples) and were evaluated for the presence of enterovirus, cytomegalovirus (CMV), adenovirus, and herpes simplex virus (HSV) using PCR primers designed to consensus and unique sequences of these viral genomes. Blood also was obtained at the time of biopsy (11) or transplant (18). In 26 of 38 myocardial samples (68%), viral genome was detected by PCR (15 adenoviral, 8 enteroviral, 2 HSV, 1 CMV), whereas all control myocardial samples and blood samples were negative. Four patients had positive viral cultures, and these matched the PCR findings. Disagreement with histopathology occurred in 13 of 26 PCR-positive specimens, usually associated with adenovirus. Conclusions: PCR offers a rapid, sensitive diagnostic method for myocardial viral infection. While enterovirus is an important etiological agent, adenovirus was more prevalent in this series and should be evaluated when etiology is sought PCR used in conjunction with standard endomyocardial biopsy appears to enhance the likelihood of detecting viral genome in the myocardium of patients with clinical evidence of myocarditis.

AB - Background: The diagnosis of viral myocarditis remains difficult and generally depends on clinical and histological criteria. Viral cultures and serology are often unrewarding, with low yields. The purpose of this study was to analyze the usefulness of polymerase chain reaction (PCR) in the rapid diagnosis of acute myocarditis in children. Methods and Results: PCR was used to analyze 38 myocardial tissue samples from 34 patients with suspected acute viral myocarditis and 17 control patients with congenital heart disease (14) or hypertrophic cardiomyopathy (3). Myocardial samples were obtained at the time of right ventricular biopsy (13 samples), from explanted hearts (18 samples) at transplantation, and from cardiac autopsy specimens (24 samples) and were evaluated for the presence of enterovirus, cytomegalovirus (CMV), adenovirus, and herpes simplex virus (HSV) using PCR primers designed to consensus and unique sequences of these viral genomes. Blood also was obtained at the time of biopsy (11) or transplant (18). In 26 of 38 myocardial samples (68%), viral genome was detected by PCR (15 adenoviral, 8 enteroviral, 2 HSV, 1 CMV), whereas all control myocardial samples and blood samples were negative. Four patients had positive viral cultures, and these matched the PCR findings. Disagreement with histopathology occurred in 13 of 26 PCR-positive specimens, usually associated with adenovirus. Conclusions: PCR offers a rapid, sensitive diagnostic method for myocardial viral infection. While enterovirus is an important etiological agent, adenovirus was more prevalent in this series and should be evaluated when etiology is sought PCR used in conjunction with standard endomyocardial biopsy appears to enhance the likelihood of detecting viral genome in the myocardium of patients with clinical evidence of myocarditis.

UR - http://www.scopus.com/inward/record.url?scp=0028318735&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0028318735&partnerID=8YFLogxK

U2 - 10.1161/01.CIR.90.1.330

DO - 10.1161/01.CIR.90.1.330

M3 - Article

VL - 90

SP - 330

EP - 339

JO - Circulation

JF - Circulation

SN - 0009-7322

IS - 1

ER -