Prevalence and Prognostic Implications of Active Cytomegalovirus Infection in Patients with Acute Heart Failure
Résumé
Objetives: Acute heart failure (AHF) causes significant morbidity and mortality. Recent studies have postulated that the expression of inflammatory mediators such as cytokines and chemokines plays an important role in the development and progression of heart failure. A proinflammatory state has been postulated as a key factor in triggering cytomegalovirus (CMV) reactivation. Therefore, we sought to determine the prevalence of active CMV infection in immunocompetent patients admitted for AHF and to quantify the association with the risk of the combined endpoint of death or AHF readmission. Design: A total of 132 consecutive patients admitted for AHF were enrolled in the study. Plasma CMV DNAemia was assessed by real-time quantitative PCR. Cytokine measurements in plasma were performed by ELISA. Clinical data were evaluated by personnel blinded to CMV results. The independent association between active CMV infection and the endpoint was determined by Cox regression analysis. Results: During a median follow-up of 120 days (IQR: 60-240), 23 (17.4%) deaths, 34 (24.2%) readmission for AHF and 45 (34.1%) deaths/readmission for AHF were identified. Plasma CMV DNAemia occurred in 11 (8.3%) patients, albeit at a low level (<100 copies/mL). The cumulative rate of the composite endpoint was higher in patients with CMV DNAemia (81.8% vs. 29.8%, p<0.001). After adjusting for established risk factors, the occurrence of CMV DNAemia was strongly associated with the clinical end-point (HR=4.39, 95% CI: 2.02-9.52; p<0.001). Conclusions: Active CMV infection occurs, though uncommonly, in patients with AHF, and may be a marker of disease severity.
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