Viral myocarditis in combination with genetic cardiomyopathy as a cause of sudden death. An autopsy series

• Published in: BMC cardiovascular disorders Vol. 24; no. 1; pp. 282 - 5
• Main Authors: Callon, Domitille, Joanne, Pierre, Andreoletti, Laurent, Agbulut, Onnik, Chevalier, Philippe, Fornès, Paul
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 29-05-2024; BioMed Central; BMC
• Subjects: Acids; Adult; Autopsies; Autopsy; Cardiac arrest; Cardiac arrhythmia; Cardiomyocytes; Cardiomyopathy; Cardiomyopathy, Dilated - genetics; Cardiomyopathy, Dilated - pathology; Cardiomyopathy, Dilated - virology; Cardiomyopathy, Hypertrophic - genetics; Cardiomyopathy, Hypertrophic - pathology; Case Report; Case studies; Cause of Death; Causes of; Channelopathy; Coinfection; Complications and side effects; Death & dying; Death, Sudden, Cardiac - etiology; Death, Sudden, Cardiac - pathology; Death, Sudden, Cardiac - prevention & control; Desmin; Dilated cardiomyopathy; Epstein-Barr virus; Epstein-Barr Virus Infections - complications; Families & family life; Fatal Outcome; Female; Genes; Genetic; Genetic analysis; Genetic aspects; Genetic Predisposition to Disease; Genetic testing; Heart; Heart diseases; Herpes viruses; Herpesvirus 4, Human - genetics; Herpesvirus 6, Human - genetics; Herpesvirus 6, Human - isolation & purification; Histology; Humans; Infections; Long QT syndrome; Male; Medical research; Medicine, Experimental; Middle Aged; Molecular biology; Mutation; Myocarditis; Myocarditis - genetics; Myocarditis - pathology; Myocarditis - virology; Parvoviridae Infections - complications; Parvovirus B19, Human - genetics; Parvoviruses; Public health; Pulmonary hypertension; Roseolovirus Infections - complications; Roseolovirus Infections - diagnosis; Roseolovirus Infections - pathology; Roseolovirus Infections - virology; Sudden cardiac death; Sudden death; Toxicology; Viral infections; Viruses; Young Adult; France; United States > US; Myocarditis; Genetic; Molecular biology; Sudden cardiac death; Cardiomyopathy
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-024-03913-z

Sudden cardiac death (SCD) is a major public health issue worldwide. In the young (< 40 years of age), genetic cardiomyopathies and viral myocarditis, sometimes in combination, are the most frequent, but underestimated, causes of SCD. Molecular autopsy is essential for prevention. Several studies have shown an association between genetic cardiomyopathies and viral myocarditis, which is probably underestimated due to insufficient post-mortem investigations. We report on four autopsy cases illustrating the pathogenesis of these combined pathologies. In two cases, a genetic hypertrophic cardiomyopathy was diagnosed in combination with Herpes Virus Type 6 (HHV6) and/or Parvovirus-B19 (PVB19) in the heart. In the third case, autopsy revealed a dilated cardiomyopathy and virological analyses revealed acute myocarditis caused by three viruses: PVB19, HHV6 and Epstein-Barr virus. Genetic analyses revealed a mutation in the gene coding for desmin. The fourth case illustrated a channelopathy and a PVB19/HHV6 coinfection. Our four cases illustrate the highly probable deleterious role of cardiotropic viruses in the occurrence of SCD in subjects with genetic cardiomyopathies. We discuss the pathogenetic link between viral myocarditis and genetic cardiomyopathy. Molecular autopsy is essential in prevention of these SCD, and a close collaboration between cardiologists, pathologists, microbiologists and geneticians is mandatory.