Myocardial enterovirus infection with left ventricular dysfunction: a benign disease compared with idiopathic dilated cardiomyopathy

J Am Coll Cardiol. 1995 Apr;25(5):1170-5. doi: 10.1016/0735-1097(94)00517-t.


Objectives: Endomyocardial biopsy samples from patients with idiopathic dilated cardiomyopathy were screened for the presence of enterovirus genome. Patients with enterovirus-positive samples were further studied with regard to disease course, histologic variables and response to interferon-alpha treatment.

Background: Studies of patients with idiopathic dilated cardiomyopathy have reported widely divergent clinical outcomes, suggesting that there is no unique underlying pathogenetic mechanism.

Methods: Five left ventricular endomyocardial biopsy samples were screened for the presence of the enterovirus genome by an established in situ hybridization technique in combination with a histologic, histomorphometric and immunohistologic workup. The course of the disease was then prospectively followed for up to 50 months. Virus-positive patients whose condition deteriorated were treated with interferon-alpha.

Results: Of 77 patients, 20 (26%) had enterovirus-positive and 57 (74%) enterovirus-negative biopsy samples. During a mean follow-up period of 25.8 +/- 13.7 months, 1 patient in the enterovirus-positive group and 11 in the enterovirus-negative group died. Four patients in the enterovirus-negative group underwent heart transplantation (p < 0.05). The surviving 19 enterovirus-positive patients had a decrease in mean left ventricular end-diastolic diameter from 66 to 61 mm (p < 0.05) and a mean increase in left ventricular ejection fraction from 0.35 to 0.43 (p < 0.05). In contrast, enterovirus-negative patients had no significant change in end-diastolic diameter or left ventricular ejection fraction. Four patients in the enterovirus-positive group whose condition deteriorated were treated with a 6-month course of subcutaneous interferon-alpha (3 x 10(6) U every second day). This treatment induced hemodynamic improvement in all four patients and eliminated the persistent enteroviral infection in two.

Conclusions: Enterovirus-positive patients have a better heart transplantation-free survival rate and hemodynamic course, with fewer histologic changes, than do enterovirus-negative patients. In addition, enterovirus-positive patients respond favorably to interferon-alpha treatment. These observations indicate that myocardial enteroviral infection with associated left ventricular dysfunction is a distinct disease entity with a benign course.

Publication types

  • Clinical Trial
  • Comparative Study

MeSH terms

  • Cardiac Catheterization
  • Cardiomyopathy, Dilated / pathology
  • Cardiomyopathy, Dilated / therapy
  • Cardiomyopathy, Dilated / virology*
  • Endocardium / pathology
  • Endocardium / virology
  • Enterovirus Infections / pathology*
  • Enterovirus Infections / therapy
  • Female
  • Follow-Up Studies
  • Genome, Viral
  • Heart / virology
  • Humans
  • In Situ Hybridization
  • Interferon alpha-2
  • Interferon-alpha / therapeutic use
  • Longitudinal Studies
  • Male
  • Middle Aged
  • Myocarditis / pathology
  • Myocarditis / therapy
  • Myocarditis / virology*
  • Myocardium / pathology
  • Recombinant Proteins
  • Time Factors
  • Ventricular Dysfunction, Left / pathology
  • Ventricular Dysfunction, Left / therapy
  • Ventricular Dysfunction, Left / virology*


  • Interferon alpha-2
  • Interferon-alpha
  • Recombinant Proteins