Cytomegalovirus infection activity as a predictor of adverse clinical events in chronic heart failure

Aim. To evaluate the impact of cytomegalovirus (CMV) infection on the course of chronic heart failure (CHF) over a 24-month prospective follow-up.
Material and methods. The study included patients (n = 151) hospitalized due to CHF decompensation. Based on a follow-up, they were divided into groups with favorable and adverse CHF course, underlying pathology, and their complications. The adverse CHF course group included patients who experienced at least one of the following events during the 24-month follow-up period: 1) hospitalization for CHF decompensation; 2) adverse clinical events (cardiovascular death, nonfatal myocardial infarction or acute cerebrovascular accident, and pulmonary embolism); 3) any deterioration in CHF class; 4) a decrease in left ventricular ejection fraction (LVEF) by more than 10% from baseline. Plasma CMV DNA levels were assessed at baseline and after 12 and 24 months of followup. To identify predictors of the development of adverse cardiovascular events, ROC analysis was used with the construction of characteristic curves and the calculation of the area under the curve (AUC).
Results. In patients with an adverse CHF course, CMV DNA levels at study inclusion were significantly higher (p < 0.001) compared to those with a favorable CHF course 2,232.0 copies/ml [1,687.0; 2,765.0] and 1,245 copies/ml [991.3; 1,592.0], respectively. The CMV DNA blood plasma level showed a direct correlation with CHF FC (r = 0.66; p = 0.001) and left ventricular end-diastolic dimension (r = 0.53; p = 0.01), while showing a inverse correlation with LVEF (r = –0.49; p = 0.001). The CMV DNA level greater than 1,687 copies/ml predicts adverse cardiovascular events (sensitivity 67%, specificity 81%, AUC = 0.763; p < 0.001) and death (sensitivity 68% and specificity 92%, AUC = 0.844, p < 0.001) in CHF patients over 24 months.
Conclusion. To stratify the risk of developing adverse cardiovascular events during a 24-month follow-up period after CHF decompensation, it is advisable to determine the concentration of cytomegalovirus DNA in the blood of patients with coronary artery disease.

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