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DOI: 10.1055/s-0031-1297552
Anticardiac antibodies and viral persistence in pericardial effusion of patients with pericarditis
Objectives: Establishing the underlying cause of a pericardial disease is still an everyday challenge to the clinicians. With the application of standard clinical, biochemical and cytological methods only, the etiological search is often inconclusive. More precise diagnostic tools, such as pericardial fluid and tissue analysis are required to identify the definite cause in these cases.
Materials and methods: Samples from 44 patients who suffered from acute or chronic pericardial effusion (PE) and who underwent pericardiocentesis and pericardioscopically guided pericardial biopsy for therapeutic and/or diagnostic reasons, were compared with plasma samples and pericardial fluid (PF) from 26 patients, which were obtained during open heart surgery for coronary artery disease. The levels of antimyolemmal and anti-fibrillary antibodies antibodies in PE and plasma (Pl) from patients with pericardial effusion as well as PF and Pl from controls and the presence of cardiotropic viral or bacterial agents in all samples were determined and compared.
Results: Overall levels of anti-myolemmal (AMLA) and anti-fibrillary antibodies (AFA) in PF and Pl were significantly higher in patients with pericardial disease than in patients of the control group (AMLA: p=0.002 for PF and p<0.001 for serum; AFA: p<0.001 for PF and p<0.001 for serum). Patients with pericardial disease had significantly higher AFA-IgG levels in the PF and significantly higher AFA-IgM and AFA-IgA levels in the Pl compared to the control group. Viral or bacterial genome could not be detected by PCR analysis in any of the PF and Pl samples from patients of the control group, whereas 19 of 44 (43%) patients with pericardial effusion had detectable viral genome in PF or epicardial biopsies.
Conclusions: The identification of elevated anticardiac antibodies in pericardial effusion and plasma indicates increased immunological reactivity in viral and autoimmune forms of pericarditis. In combination with molecular techniques as PCR it is possible to provide an accurate diagnosis which improves sensitivity, specificity and diagnostic accuracy in patients with pericardial diseases and permits specific treatment.