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), CMVIgG/ 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 acutecases 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.
Cento, V., Colagrossi, L., Bossi, I., Armenia, D., Nava, A., Piccinelli, E., et al. (2023). CMV seroprevalence and coronary CMV-DNA detection in immunocompetent patients with heart diseases. MINERVA MEDICA, 114(3 (June 2023)), 289-299 [10.23736/S0026-4806.22.07778-3].
CMV seroprevalence and coronary CMV-DNA detection in immunocompetent patients with heart diseases
Piccinelli, E;Maloberti, A;Romeo, F;Giannattasio, C;
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), CMVIgG/ 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 acutecases 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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