Productive Cytomegalovirus Infection Is Associated With Impaired Endothelial Function in ST-Elevation Myocardial Infarction

Abstract

Background: An association between productive cytomegalovirus infection and atherosclerosis was shown recently in several trials, including a previous study of ours. However, the mechanism involved in this association is still under investigation. Here, we addressed the interaction between productive cytomegalovirus infection and endothelial function in patients with ST-elevation myocardial infarction (STEMI).

Methods: We analyzed the presence of cytomegaloviral DNA in plasma and endothelial function in 33 patients with STEMI and 33 volunteers without cardiovascular diseases, using real-time polymerase chain reaction (PCR) and a noninvasive test of flow-mediated dilation.

Results: Both the frequency of presence and the load of cytomegaloviral DNA were higher in plasma of patients with STEMI than those in controls. This difference was independent of other cardiovascular risk factors (7.38 [1.36-40.07]; P = 0.02). The results of the flow-mediated dilation test were lower in patients in STEMI than in controls (5.0% [2.65%-3.09%] vs 12. %5 [7.5%-15.15%]; P = 0.004) and correlated negatively with the cytomegaloviral DNA load (Spearman R = -0.407; P = 0.019) independently of other cardiovascular risk factors.

Conclusions: Productive cytomegalovirus infection in patients with STEMI correlated negatively with endothelial function independently of other cardiovascular risk factors. The impact of cytomegalovirus on endothelial function may explain the role of cytomegalovirus in cardiovascular prognosis.

Keywords: Cytomegalovirus; Endothelial function; Flow-mediated vasodilation; Polymerase chain reaction; ST-elevation myocardial infarction.

Figure 1. Cytomegaloviral DNA loads in controls and STEMI patients.

Presented are the medians and interquartile range of the amounts of cytomegaloviral DNA copies per 1ml of plasma for volunteers without cardiovascular diseases and patients with STEMI. * Differences are statistically significant at p < 0.05.

Figure 2. Multiple logistic regression analysis of cardiovascular risk factors and presence of cytomegalovirus in STEMI patients and controls.

Presented are the odds ratios for binomial cardiovascular risk factors (with age ≥ 55 years for males and ≥ 65 years for females, and hs-CRP level ≥2 mg/l) and the presence of productive cytomegalovirus infection (>1,000 copies of DNA/ml of plasma) in the multiple regression model for comparison of STEMI patients and volunteers without cardiovascular diseases. * Differences are statistically significant at p < 0.05.

Figure 3. Flow-mediated dilation test results in controls and STEMI patients.

Presented are the medians and interquartile ranges of the flow-mediated dilation test results in volunteers without cardiovascular diseases and patients with STEMI. * Differences are statistically significant at p < 0.05.

Figure 4. Correlation between cytomegaloviral DNA loads and flow-mediated dilation test results.

Presented is the correlation with 95% confidential interval according to Spearman Rank test between cytomegaloviral DNA loads and flow-mediated dilation test results in all participants. * Correlation is statistically significant at p < 0.05.