BacKGrOUNd: acute coronary syndromes (acS) are a major cause of morbidity and mortality. as cytomegalovirus (cMV) may contribute to cardio-vascular (cV) manifestations, we sought to provide a proof-of-concept for the involvement of coronary and/or systemic cMV-reactivation as a possible acS trigger. MeTHOdS: We prospectively enrolled consecutive patients undergoing a coronary angiography for acS (acute-cases, N.=136), or non-acS reasons (chronic-cases, N.=57). Matched coronary and peripheral blood-samples were processed for quantification of CMV-DNAemia (RT-PCR), CMV-IgG/IgM, and CMV-IgG avidity (ELISA). Peripheral-blood samples from 17 healthy subjects were included as controls. RESULTS: Out of the 193 cases included, 18.1% were aged ≤55 years, 92.5% were Central-European, and 100% immunocompetent. CMV-IgG seroprevalence was 91.7% (95%CI: 87.8-95.6), significantly higher than in healthy-controls (52.9% [95%ci: 29.2-76.5]; P<0.001), yet consistent across age-groups (P=0.602), male/females (P=0.765), and acute/ chronic-cases (P=0.157). Median (iQr) igG titers were 110 (84-163) aU/mL, with 0.62 (0.52-0.72) avidity, supporting a long history of infection. No acute cMV infections were found. in 22.6% (n/N.=40/177) of the igG-positive cases low-level coronary and/or systemic cMV-dNaemia (always <40 copies/mL) was detected. While no differences in peripheral cMV-dNaemia prevalence were observed nor among cases nor controls, coronary cMV-dNaemia was more frequent in acute-cases without modifiable CV risk-factors (n/N.=4/10; 40.0%), than in chronic-cases (n/N.=6/55, 10.9%; P=0.029), or acute-cases with risk-factors (n/N.=16/112, 14.3%; P=0.058). cONcLUSiONS: cMV-igG seroprevalence was high in patients with heart diseases. cMV-dNaemia can be found, although uncommonly, in coronary circulation during an acS, with increased prevalence in older subjects and in absence of CV risk-factors, identifying possible areas for novel interventions.
cMV seroprevalence and coronary cMV-dNa detection in immunocompetent patients with heart diseases / V. Cento, L. Colagrossi, I. Bossi, D. Armenia, A. Nava, E. Piccinelli, A. Maloberti, E. Inglese, E. Matarazzo, F.D.I. Ruscio, P. Paba, F. Marcuccilli, M. Perrone, G. Chiricolo, C. Alteri, F. Scaglione, C. Vismara, D.A. Campisi, D. Fanti, F. Romeo, M. Andreoni, F. Oliva, F. Ceccherini-Silberstein, C. Giannattasio, C.F. Perno. - In: MINERVA MEDICA. - ISSN 0026-4806. - 114:3(2023 May), pp. 289-299. [10.23736/S0026-4806.22.07778-3]
cMV seroprevalence and coronary cMV-dNa detection in immunocompetent patients with heart diseases
C. Alteri;F. Scaglione;
2023
Abstract
BacKGrOUNd: acute coronary syndromes (acS) are a major cause of morbidity and mortality. as cytomegalovirus (cMV) may contribute to cardio-vascular (cV) manifestations, we sought to provide a proof-of-concept for the involvement of coronary and/or systemic cMV-reactivation as a possible acS trigger. MeTHOdS: We prospectively enrolled consecutive patients undergoing a coronary angiography for acS (acute-cases, N.=136), or non-acS reasons (chronic-cases, N.=57). Matched coronary and peripheral blood-samples were processed for quantification of CMV-DNAemia (RT-PCR), CMV-IgG/IgM, and CMV-IgG avidity (ELISA). Peripheral-blood samples from 17 healthy subjects were included as controls. RESULTS: Out of the 193 cases included, 18.1% were aged ≤55 years, 92.5% were Central-European, and 100% immunocompetent. CMV-IgG seroprevalence was 91.7% (95%CI: 87.8-95.6), significantly higher than in healthy-controls (52.9% [95%ci: 29.2-76.5]; P<0.001), yet consistent across age-groups (P=0.602), male/females (P=0.765), and acute/ chronic-cases (P=0.157). Median (iQr) igG titers were 110 (84-163) aU/mL, with 0.62 (0.52-0.72) avidity, supporting a long history of infection. No acute cMV infections were found. in 22.6% (n/N.=40/177) of the igG-positive cases low-level coronary and/or systemic cMV-dNaemia (always <40 copies/mL) was detected. While no differences in peripheral cMV-dNaemia prevalence were observed nor among cases nor controls, coronary cMV-dNaemia was more frequent in acute-cases without modifiable CV risk-factors (n/N.=4/10; 40.0%), than in chronic-cases (n/N.=6/55, 10.9%; P=0.029), or acute-cases with risk-factors (n/N.=16/112, 14.3%; P=0.058). cONcLUSiONS: cMV-igG seroprevalence was high in patients with heart diseases. cMV-dNaemia can be found, although uncommonly, in coronary circulation during an acS, with increased prevalence in older subjects and in absence of CV risk-factors, identifying possible areas for novel interventions.
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