ABSTRACT
Over the past 20 years, the use of PCR has increased our understanding about possible cardiotropic viruses in patients with unexplained cardiomyopathy. Numerous studies of patients with myocarditis or dilated cardiomyopathy have reported a wide range of viruses including enteroviruses (most commonly Coxsackie B virus), adenoviruses, Parvovirus B19, cytomegalovirus, influenza and respiratory syncytial virus, Ebstein-Barr virus, HIV, Hepatitis C virus, and human herpes virus 6 (81-87). There are several limitations to the widespread use of PCR in screening endomyocardial biopsy samples for cardiotropic viruses. Currently available PCRbased viral isolation techniques remain labor intensive, costly, and lack standardization. Existing PCR screening methods are also restricted to a limited number of predetermined candidate viruses. Because the number of biopsy samples needed to attain a clinically acceptable sensitivity for cardiotropic viruses is not known, a positive PCR is diagnostic of viral infection, however, a negative PCR does not exclude viral infection. Lastly, and most importantly, presence of viral genomic material in biopsy specimens does not prove causality of cardiomyopathy and currently does not change management strategy.
