Intravenous immunoglobulin therapy for patients with idiopathic cardiomyopathy and endomyocardial biopsy-proven high PVB19 viral load

Background: Parvovirus B19 (PVB19) persistence in the heart has been associated with progressive cardiac dysfunction and evolution to dilated cardiomyopathy. In the present study, we investigated whether immunomodulation with intravenous immunoglobulin (IVIg) in addition to conventional heart failure therapy is safe and achieves virus reduction. Such therapy might improve cardiac function in patients with chronic dilated cardiomyopathy (DCM) and a significant PVB19 viral load in the heart. Methods: PVB19 viral load was studied in 25 post-mortem cardiac samples of patients with a normal heart. Then, 17 consecutive patients (mean age 53 +/- 3 years) with DCM and symptomatic heart failure for >1 year with a PVB19 viral load in endomyocardial biopsies of >250 copies/mu g DNA were treated with a high dose of IVIg (2 g/kg). Results: The post-mortem cardiac samples revealed a PVB19 presence in 80% with a mean load of 131 +/- 40 copies/mu g DNA. In the treated patients, IVIg resulted in a significant decrease of PVB19 viral load from 1,420 +/- 216 to 619 +/- 200 copies/mu g DNA (P=0.004) and significantly improved the ejection fraction from 33 +/- 3% 6 months before treatment and 34 +/- 3% at baseline to 41 +/- 3% 6 months (P=0.001) after IVIg therapy. The New York Heart Association classification significantly improved from 2.5 +/- 0.1 at baseline to 2.1 +/- 0.1 at follow-up (P=0.004). No therapy-related complications were noted. Conclusion: The present pilot study demonstrates that IVIg significantly reduces viral load and improves cardiac function in patients with DCM related to increased PVB19 viral load in the heart.