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Some aspects of the clinical manifestation of dilated cardiomyopathy of viral etiologies
 K. A. Nadaraia
National Center of Therapy

OBJECTIVES. Nowadays the study of different etiological agents of Dilated Cardiomyopathy (DCM) is of big importance. Among these factors cardiotropic viral infections are most important and the theory of transplantation of Viral Myocarditis (VM) to DCM is accepted undoubtedly. The purpose of the research was to study the frequency of manifestation and causative factors of essential etiological forms of DCM, particularly those of viral etiology and evaluate and compare the severity of clinical manifestation of these viral and unviral etiological forms. METHODS. We have studied 84 patients with DCM. 70 of them were males and 14 - were females. Mean age was 41.8±3.2 years, ranging from 16 to 67. Patients suspected of having Ischemic Cardiomyopathy were excluded from the study. Routine clinical assays, Doppler-echocardiography, X-ray photography, 24h ECG Holter monitoring, treadmill test, serological analysis for revealing the antibodies against cardiotropic viruses were performed. The frequency of manifestation of some unfavorable prognosis predictors of DCM were evaluated in the groups created according to viral and unviral etiological forms of DCM. Each variable was evaluated and comparisons within the groups were performed by the student’s test and Chi-square test. RESULTS. Out of 84 cases of DCM we detected viral infection in the history of disease and a positive serologic reaction to the cardiotropic viruses In 45 (54%) cases. 3 cases were postpartum, 2 - alcoholic DCM and in 34 cases we couldn’t detect any etiological factories. Out of 45 cases of viral DCM 20 (44.4%) were caused by Coxsackie B viral infection; 8 (17.8%) by adenoviruses and 10 (22.2%) by the influenza A virus. In isolated instances we detected Cytomegalovirus, Herpes virus, ECHO virus, Hepatitis C virus, Coxsackie A virus and influenza B viruses. The frequency of manifestation of a number of predictors of the unfavorable prognosis of DCM among the patients with viral DCM was lower as compared to the patients with the unviral DCM (p<0.05): Heart failure functional class III-IV (NYHA) – 77.8% vs 87.2% respectively; Left ventricular end-diastolic diameter > 7cm – 57.8% vs 69.2%; Mitral-septal separation > 2.5cm – 51.1% vs 64.1%; Thromboembolies – 24.4% vs 38.5%; Left bundle branch block – 31.1% vs 38.5%. However, frequency of atrial fibrillation among the patients with viral DCM was highly – 33.3% vs 28.2%. The existing difference between other predictors was considered statistically not significant (p>0.05): Ejection fraction < 30% – 42.2% vs 43.6% respectively; Ventricular arrhythmia – 86.7% vs 92.3%. CONCLUTIONS. We can conclude that more than half of cases (54%) of DCM is of viral etiology and represents the result of transformation of VM into DCM. Coxsackie B viruses, too less extent Influenza A viruses and Adenoviruses are characterized by particular cardiotropic activity and can be considered the main and the most prevalent cause of transformation. As to severity of clinical manifestation, DCM of viral etiologies is characterized by lower frequency of revealing of unfavorable prognosis predictors, in comparison with cases of unviral DCM.

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